Dosing Suggestions

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

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.

High-CBD Formulation (20:1) — typically given twice/day

Primary Medical Ingredient: CBD
Dosage Forms & Strengths: Tincture or Oral Spray; 100mg CBD/mL & 5mg THC/mL

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 (= total of 10-30 mg/day THC)

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 (1:1 or 3:1)—may be given once/day at night or divided twice/day

Primary Medical Ingredient: THC
Dosage Forms & Strengths: Tincture; 5mg THC/mL with either 5mg CBD/mL (for 1:1) or 15 mg CBD/mL (for 3:1)

For Patients Over 50kg:
• Start at 5 mg THC (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 (0.5mL) once at night or divided twice daily
• Increase every 1-2 weeks by 2.5 mg THC per day
• Target dose = amount needed to benefit symptoms with fewest side effects

For Patients 10 – 20 kg:
• Start at 1 mg THC (0.2mL) 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

Dosage Modification
• For patients with anxiety, consider prescribing 3:1 formulation (15mg CBD/mL)

Medically sensitive patients, such as children under two or those taking multiple concomitant seizure medications, should be started at a lower dose and titrated more slowly. Less sensitive patients can be started at a somewhat higher initial dosage.

A prescribed dose of the medication should be placed inside the mouth between the cheek and gums or on 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.

Prescribers – for more information on medical cannabis, please contact Compassionate Cultivation for a welcome package.

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