Last updated on September 2nd, 2019 at 09:45 am

Dosing Recommendations

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

As with any new medication, dosage recommendations for cannabidiol (CBD) medicines are best established according to scientific research and high-quality anecdotal evidence from individual patients. CBD does not come with a dosing range approved by the FDA. New FDA-approved drugs include dose ranges approved in clinical trials; the actual dosing ranges become apparent as more patients use the medicine and as both prescribers and patients determine the dosing that works.

As a practicing epileptologist, I devised the guidelines below for patients with intractable epilepsy based on published data from clinical trials, and have refined the approach based on experience with more than 100 patients I have written prescriptions for since February 2018. This is a starting point, with the expectation that some patients may require higher doses. Guidelines for other conditions will require similar research and subsequent adjustments based on accruing experience – including full consideration of the ideal ratio of CBD:THC as allowed in the recently expanded CUP program.

For each patient, CBD dosing will depend on:

  • Product formulation (e.g. CBD concentration, THC concentration).
  • Patient characteristics, including weight, age and medications patient is already taking. For instance, one common seizure medication often used in refractory patients – clobazam (Onfi) – has a strong interaction with CBD. Patients taking Onfi should start on lower CBD doses and be titrated more gradually even if Onfi is the only other seizure medication the patient is taking when initiating CBD treatment.
  • Initial dose and rate of titration both need to be considered.
  • 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.
  • Dose increments of <0.1ml are not feasible to measure, so round to 0.1 ml instead of 0.05 ml increments. The half-life is long, so once/day dosing is fine for small doses; split to twice/ day if volume makes oral absorption difficult or if the dose starts to cause sleepiness.

Doses should be given in cheek or under tongue ideally; if swallowed, should be given with some fatty food to increase absorption.

Higher doses have been utilized in some clinical trials, but may not be necessary in all patients to achieve good seizure control. These higher doses may be well tolerated, but we need more experience with the Lone Star product to understand the ranges our patients need for optimal response with minimal side effects.

Low Dose Initiation in Children

  • 0.5 mg/kg/day, minimum dose 10 mg = 0.1 ml.
  • Increase every 1-2 weeks by 0.5-1 mg/kg/day, rounding to nearest 10 mg (0.1 ml increments) as long as side effects don’t interfere.
  • Target dose 2-10 mg/kg/day; average is 2-6 mg/kg/day.

Low Dose in Adults (or Children Weighing >50 KG)

  • 25 mg twice daily.
  • Increase every 1-2 weeks by 25 mg/dose.
  • Target dose 100-300 mg twice daily if tolerated. Stop sooner if seizures stop or side effects prevent further dose increases.

Higher Dose Initiation in Children

  • 1 mg/kg/day, minimum 10 mg = 0.1 ml.
  • Increase every 1-2 weeks by 1 mg/kg/day, as long as side effects do not interfere.
  • If side effects are a problem, go up more gradually with more time between dose increases.
  • Target dose 2-10 mg/kg/day, average is 2-6 mg/kg/day.

Higher Dose in Adults (or Children Weighing >50 KG)

  • 50 mg twice daily.
  • Increase every 1-2 weeks by 50 mg/dose.
  • Target dose 100-300 mg twice daily if tolerated. Stop sooner if seizures stop or side effects prevent further dose increases.

Prescribers – for a free dosing wheel and other helpful information, please contact Compassionate Cultivation for a welcome package.

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