Palatability and oral cavity tolerability of THC:CBD oromucosal spray and possible improvement measures in multiple sclerosis patients with resistant spasticity: a pilot study

Neurodegener Dis Manag. 2018 Apr;8(2):105-113. doi: 10.2217/nmt-2017-0056. Epub 2018 Apr 23.


Aim: Complaints about Δ9-tetrahydrocannabinol (THC):cannabidiol (CBD) oromucosal spray (Sativex®; GW Pharma Ltd, Salisbury, UK) in the management of multiple sclerosis spasticity include unpleasant taste and oral mucosal anomalies. This pilot study assessed the use of sugar-free chewing gum and/or a refrigerated bottle of THC:CBD oromucosal spray to mitigate these effects.

Materials & methods: Patients with multiple sclerosis spasticity (n = 52) at six sites in Italy who were receiving THC:CBD oromucosal spray and had associated oral mucosal effects were randomized into Group A (chewing gum; n = 15); Group B (cold bottle; n = 20); and Group C (cold bottle + chewing gum; n = 17).

Results: Taste perception in patients receiving chewing gum ± cold bottle intervention (Groups A and C combined) was significantly (p = 0.0001) improved from baseline to week 4 while maintaining spasticity control.

Conclusion: Patient comfort, satisfaction and treatment adherence may benefit from these interventions.

Keywords: Sativex; THC:CBD; multiple sclerosis; oral cavity complaints; oromucosal spray; spasticity; taste perception.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analgesics / therapeutic use*
  • Cannabidiol / therapeutic use*
  • Dronabinol / therapeutic use*
  • Drug Combinations
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mouth / drug effects*
  • Mouth / physiology
  • Multiple Sclerosis / complications
  • Multiple Sclerosis / drug therapy
  • Muscle Spasticity / drug therapy*
  • Muscle Spasticity / etiology
  • Pilot Projects
  • Prospective Studies
  • Stomatitis / chemically induced
  • Taste / drug effects*
  • Taste Perception / drug effects*
  • Treatment Outcome


  • Analgesics
  • Drug Combinations
  • Cannabidiol
  • Dronabinol
  • nabiximols