COVID-19 and CBD
COVID-19 and CBD
COVID-19

COVID-19 is caused by a type of coronavirus called 'severe acute respiratory syndrome coronavirus 2' (SARS-CoV-2). The World Health Organization (WHO) declared a Public Health Emergency of International Concern on 30 January 2020 and a pandemic on 11 March 2020 [1],[2]. COVID-19 is more contagious than the common flu and causes more severe complications in some people [3]. These complications often take the form of Acute Respiratory Distress Syndrome (ARDS) and multiple organ failure in the later stages of the illness or even during recovery [4],[5]. 

One of the causes of these life-threatening complications, and subsequently the severity of the disease overall, is a physiological reaction of the innate immune system. Excessive amounts of pro-inflammatory molecules (cytokines) are released — the so-called "cytokine storm’’ [6],[7]. If therapeutics are able to prevent the overreaction of our immune system, then fewer patients would need immediate hospitalization, reducing the mortality rate caused by COVID-19 and freeing up much-needed hospital capacity to treat other illnesses. Yet we know of few medications that can act as a preventive mechanism for such a response. One such drug is the monoclonal antibody called bamlanivimab (single dose of 700 mg via IV infusion over 60 minutes), which the FDA approved for use as an early treatment of mild-to-moderate COVID-19. The clinical evidence so far suggests that it reduces COVID-19-related hospitalization or emergency room visits in patients at high risk within 28 days after treatment compared to a placebo [8].

CBD and COVID-19

There is strong preclinical evidence that cannabidiol and cannabis extracts high in cannabidiol could also halt the unwanted overreaction of the immune system against the virus. It shows an effect on the immune system, targeting enzymes that act as a gateway to cells for the virus, namely the angiotensin-converting enzyme 2 (ACE2) and the transmembrane serine protease 2 (TMPRSS2), while also affecting transcription factors responsible for inflammatory responses, such as PPARγ and NF-κB [9]-[11]. These results lay the foundation for two potential applications of CBD against SARS-CoV2. First, it could serve as a preventive mechanism in the form of nasal spray, nasal ointment, oral gel, or mouthwash. These topical solutions could reduce SARS-CoV2 entry into susceptible hosts [11]. Second, it could be used as a therapeutic agent in the early stages of the disease to avoid an inflammatory over-response or in recovered patients to prevent possible pulmonary fibrosis [12]. Another trial is set to begin in 2021 that looks at the effect of adding CBD to the steroid treatment of patients in life-threatening conditions. If it shows beneficial results, it will expand to a second phase multi-center clinical trial [13]. 

PBG Global®, together with our external partners, have also investigated CBD’s antiviral properties in vitro using, among others, a human coronavirus strain. We showed that cells treated with CBD have a lower viral load compared to the control group, a result that can be explained by the regulation of the gateway enzymes stated above.

Dosing recommendations
for patients with COVID-19 and other viral infections

Is CBD safe? 

Yes. CBD is considered safe for COVID-19 and other viral infections. 

What is the recommended daily dose? 

Prevention: 2 mg/kg/day. Treatment: 6 mg/kg/day. Start at 1 mg/kg/day and increase 0.5 mg/ kg/day if tolerated well. Read General recommendations

Should I take it before or after a meal? 

CBD should be taken during, or after a meal. 

How many times a day should I take CBD? 

Take your dose twice a day. Half of it in the morning and the other half in the evening. 

Are there any known drug interactions? 

Some. Read Side effects for more information. 

Bibliography

1. (WHO) WHO: (Press release) "WHO Director-General's opening remarks at the media briefing on COVID-19 – 11 March 2020". 11 March 2020. 

2. (WHO) WHO: ''Statement on the second meeting of the Interna- tional Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV)''. 30 January 2020. 

3. Prevention CfDCa: https://www.cdc.gov/coronavirus/2019-ncov/ symptoms-testing/symptoms.html. 13 May 2020. 

4. Cheng JL, Huang C, Zhang GJ, et al: [Epidemiological characteristics of novel coronavirus pneumonia in Henan]. Zhonghua Jie He He Hu Xi Za Zhi 43: 327-331, 2020. 

5. Ye Q, Wang B and Mao J: The pathogenesis and treatment of the `Cytokine Storm' in COVID-19. The Journal of infection 80: 607-613, 2020. 

6. Chousterman BG, Swirski FK and Weber GF: Cytokine storm and sepsis disease pathogenesis. Seminars in Immunopathology 39: 517-528, 2017. 

7. Shimabukuro-Vornhagen A, Gödel P, Subklewe M, et al: Cytokine release syndrome. Journal for ImmunoTherapy of Cancer 6: 56, 2018. 

8. FDA NEWS RELEASE: Coronavirus (COVID-19) Update: November 9, 2020. https://wwwfdagov/news-events/press-announcements/coronavi- rus-covid-19-update-november-9-2020 

9. Kozela E, Pietr M, Juknat A, Rimmerman N, Levy R and Vogel Z: Cannabinoids Delta(9)-tetrahydrocannabinol and cannabidiol differen- tially inhibit the lipopolysaccharide-activated NF-kappaB and interfer- on-beta/STAT proinflammatory pathways in BV-2 microglial cells. The Journal of biological chemistry 285: 1616-1626, 2010. 

10. Mammana S, Cavalli E, Gugliandolo A, et al: Could the Combination of Two Non-Psychotropic Cannabinoids Counteract Neuroinflammation? Effectiveness of Cannabidiol Associated with Cannabigerol. Medicina (Kaunas) 55: 747, 2019. 

11. Wang B, Kovalchuk A, Li D, et al: In search of preventive strategies: novel high-CBD Cannabis sativa extracts modulate ACE2 expression in COVID-19 gateway tissues. Aging 12: 22425-22444, 2020. 

12. Esposito G, Pesce M, Seguella L, et al: The potential of cannabidiol in the COVID-19 pandemic. Br J Pharmacol 177: 4967-4970, 2020. 

13. https://www.israel-cannabis.com/press-release/stero-biotechs-an-nounce-an-ip-protected-clinical-trial-for-covid-19-patients-using-a-cbd- steroid-treatment/