Like most new medications, dosage recommendations for cannabis medicines are best established according to existing scientific research, careful integration of high-quality anecdotal evidence, and incorporation of individual patient outcomes. Finding the correct dose will be different for each patient, determined through a titration process guided by their physician. As more patients join the program and the knowledge base for physicians grows, prescribers will gain a better understanding of efficacy and how patients tolerate medical cannabis treatment.

The most important consideration in dosage and administration is to start at a very low dose and increase the dose slowly to determine the optimal efficacy while minimizing side effects. People with no prior experience using cannabis medicine should be especially careful to follow this guidance.

DR. KAREN KEOUGH, Pediatric Neurologist & Epileptologist
Chief Medical Officer, Compassionate Cultivation

High-CBD Formulation (20:1)

typically given twice/day

Primary Medical Ingredient

CBD

Dosage Strengths

100 mg CBD & 5 mg THC per mL

Available Sizes

15 mL (1500 mg CBD)
30 mL (3000 mg CBD)

For Patients Over 50kg

Start at 25mg CBD twice daily
Increase every 1-2 weeks by 25 mg CBD/dose twice daily
Target dose 100-300 mg CBD twice daily, if tolerated

For Patients Under 50kg

0.5 mg CBD/kg/day; minimum dose 10mg CBD (0.1 mL)
Increase every 1-2 weeks by 0.5 mg CBD/kg/day; rounding to the nearest 10 mg CBD (0.1mL)
Target dose ranges from 2-10 mg CBD/kg/day, if tolerated (= total of 0.1-0.5 mg THC/kg/day)

Balanced Formulation (3:1)

may be given once/day at night or divided twice/day

Primary Medical Ingredient

THC

Dosage Strengths

15 mg CBD & 5 mg THC per mL

Available Sizes

30 mL (450 mg CBD + 150 mg THC)

For Patients Over 50kg

Start at 2.5 – 5 mg THC (0.5 – 1 mL) given once at night or divided twice daily
Increase every 1-2 weeks by 2.5 mg (0.5 mL) THC per day
Target dose = amount needed to benefit symptoms with fewest side effects

For Patients 20 – 50kg

Start at 2.5 mg THC (0.5 mL) once at night or divided twice daily
Increase every 1-2 weeks by 2.5 mg THC/day
Target dose = amount needed to benefit symptoms with fewest side effects

For Patients 10 – 20 kg

Start at 1 mg THC (0.2 mL) once at night or divided twice daily
Increase every 1-2 weeks by 1 mg (0.2 mL) THC per day
Target dose = amount needed to benefit symptoms with fewest side effects

Balanced Formulation (1:1)

may be given once/day at night or divided twice/day

Primary Medical Ingredient

THC

Dosage Strengths

10 mg CBD & 10 mg THC per mL

Available Sizes

30 mL (300 mg CBD + 300 mg THC)

For Patients Over 50kg

Start at 2.5 – 5 mg (0.25-0.5 mL) THC given once at night or divided twice daily
Increase every 1-2 weeks by 2.5 mg THC (0.25 mL) per day
Target dose = amount needed to benefit symptoms with fewest side effects

For Patients 20 – 50kg

Start at 2.5 mg THC (0.25 mL) once at night or divided twice daily
Increase every 1-2 weeks by 2.5 mg THC/day (0.25 mL)
Target dose = amount needed to benefit symptoms with fewest side effects

For Patients 10 – 20 kg

Start at 1 mg THC (0.1 mL) once at night or divided twice daily
Increase every 1-2 weeks by 1 mg THC (0.1 mL) per day
Target dose = amount needed to benefit symptoms with fewest side effects

Dosage Modification

• For patients with anxiety, consider starting with 3:1 formulation (15mg CBD/mL) to gauge tolerance of THC.

Tinctures, sprays & lozenges are intended to be sublingual. A prescribed dose of the medication should be placed inside the mouth between the cheek and gums or under the tongue and allowed to be absorbed. The patient will usually feel an effect within 1-2 hours and the effect will usually last 4-6 hours, or longer. Medical cannabis can sometimes have a “biphasic effect,” where at low doses there may be one effect (wakefulness) and at higher doses the opposite effect (sleepiness). This is why titration is so important.