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Practical considerations in medical cannabis administration and dosing
Caroline A MacCallum1, Ethan B Russo2
1Faculty of Medicine, University of British Columbia, BC, Canada.
European Journal of Internal Medicine
|January 9, 2018
Summary
This guide offers clinicians essential data on cannabis pharmacology, administration, and dosing for medical use. It emphasizes limiting tetrahydrocannabinol (THC) and suggests careful titration for safe and effective cannabis therapeutics.
Area of Science:
- Pharmacology and Therapeutics
- Cannabinoid Science
Background:
- Historical medicinal use of cannabis is contrasted with recent challenges including legal status, complexity, and lack of clinical education.
- The emergence of pharmaceutical cannabis-based medicines necessitates updated clinical guidance.
Purpose of the Study:
- To provide clinicians with concise data on cannabis pharmacology, administration methods, and dosing.
- To address adverse events, drug interactions, and special considerations for cannabis therapeutics.
Main Methods:
- Review of current data on tetrahydrocannabinol (THC) and cannabidiol (CBD) pharmacology.
- Analysis of administration methods (smoking, vaporization, oral) and dosing strategies.
- Consideration of adverse events, drug interactions, and specific patient populations.
Main Results:
- Adverse events are primarily THC-related; daily THC dose should generally be limited to 30mg or less, ideally with CBD.
- Cannabidiol (CBD) may require higher doses for benefits and can mitigate THC's side effects.
- Slow titration over two weeks is recommended for initiating cannabis preparations.
Conclusions:
- Clinicians require updated knowledge on cannabis pharmacology and therapeutics due to increasing access to cannabis-based medicines.
- Safe and effective use involves understanding THC/CBD balance, appropriate dosing, slow titration, and monitoring for adverse events.
- Guidance is provided for various conditions including epilepsy, chronic pain, and palliative care, alongside special populations and safety considerations.
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