Cannabinoid dosage in clinical practice Leave a comment

If there is any parameter, within the medical practice with cannabinoids, that raises more doubts for both clinicians and patients and their families, which is undoubtedly the issue of dosage.

Normally, in medicine, the dosage of a drug is calculated by the weight of the patient, using as parameters to calculate the final dose to be administered:

The minimum or a maximum dose of the medicine (normally expressed in milligrams) to be administered per kilogram of the patient’s weight at each intake or over 24 hours (mg / kg/dose vs. mg / kg/day), when we speak of age pediatric, or by standardized dose for a weight of 70 kgs, if we speak of adult patients, the latter being able to vary slightly according to the individual’s actual weight or according to the dosage to be applied (ibuprofen, for example, can be administered in doses of 400 mg every 8 hours or 600 mg every 12 hours, in both cases, the total daily dose is 1200 mg)

For example, the dose of paracetamol for a child varies between 10-15 mg/kg/dose up to a stipulated maximum of 80 mg/kg/day, where 10 mg/kg would be the minimum dose per dose, 15 mg/kg would be the maximum dose per dose (some protocols speak of 20 mg/kg/dose) and 80 mg/kg would be the maximum daily dose, that is, the maximum that could be administered to a child in a 24-hour period. In the case of adults, doses of 500 mg per dose have been used, although for some years the use of 1000 mg (1 gram) of paracetamol per dose has been generalized, and a maximum daily dose of 4 g can be administered. Buy CBD cigarettes – regular

All these parameters, commonly used in medicine, are defined after many years of pharmacological research and after many others of clinical practice. The exposed in the previous paragraph for the case of paracetamol is applicable to the vast majority of drugs that are used today, that is, the doses used will depend on the weight of the individual, in the case of children, and on a dose standardized, in the case of adults.

Well, none of this is applicable when we use cannabis for medicinal purposes, and I will present some interesting points that will help the reader understand the complexity of dosing in a standardized way when we talk about cannabis.

Dosing THC as the only active ingredient is not the same as dosing cannabis

Until now, the vast majority of studies that have been conducted since the first human THC trials, in which perfectly quantified doses of cannabinoids have been used, have been conducted with isolated THC. In the case of an isolated molecule, THC only, whose active ingredient name is dronabinol and whose commercial name is Marinol ®, has not had excessively good efficacy results in the studies in which it has been used. On the other hand, if it has presented a significant prevalence of side effects, especially at the psychological level, because THC is better tolerated when accompanied by other cannabinoids than when it is used as monotherapy as a single molecule. The starting doses used in these studies usually vary between 2.5 mg and 10 mg (sometimes up to 20 mgs) of THC per dose, depending on the objective of the study. Doses of 2.5 mg are usually used in the elderly and in children, although, curiously, children have a greater tolerance to the psychoactive effects of cannabis than adults. This is explained by the lower density of CB1 receptors in immature brains in relation to adult brains (Franjo Grothemner). Buy CBD cigarettes – menthol online

But the reality of the clinical practice, of the day to day of the patients, is quite different since the Marinol ® (THC) is used in a minimal proportion if we compare it with the use of the herbal form, the Sativex ® , or the cannabis edibles.

For the same reasons, nabilone, whose trade name is Cesamet ® and which is a synthetic derivative of THC with a potency 10 times greater than this, presents today a very small reality of use compared to other more accessible sources of cannabinoids. , economic and above all, effective.

The only pharmaceutical-grade medicine extracted from the plant has a high variability dosage
After Marinol and Cesamet, we find Sativex ®, sublingual spray in which each administration (spray) releases a dose of 2.7 mgs of THC together with 2.5 mgs of CBD into the oral mucosa. The average dose in clinical trials with patients with multiple sclerosis is eight sprays per day (21.6 mgs of THC and 20 mgs of CBD per day) although doses higher than 12 sprays per day (32.4 mgs of THC are not recommended. and 30 mgs of CBD a day). On the other hand, although it is recommended to apply the product in two doses (one in the morning and the other at night), according to the tables presented on the page of the Spanish Agency of Medicines and Health Products, these doses are never the same, always administered a higher dose at night than in the morning. If to this we add that THC has a different bioavailability than CBD. Buy CBD flower online

To describe a more graphic example of the different bioavailability of THC and CBD, we will say that some children with drug-resistant epilepsy manage to maintain adequate levels of CBD in the blood to control their symptoms for 24 hours with a single administration per day, while with THC, To achieve this same control of symptoms in cancer patients, two daily doses of capsules developed in Israel are necessary, containing a formulation that converts THC into a “prolonged release” substance.

Cannabis is not a single molecule, there are many

When we talk about medicinal cannabis, we are talking about a substance that bases its multifaceted therapeutic potential on the fact that depending on the different combinations of cannabinoids and terpenoids, we will have a product more suitable for one or another pathology. Thus, we have varieties that are ideal for insomnia or anxiety problems, while at the other extreme we find varieties with a powerful euphoric and antidepressant effect. This variability in effects is not exclusively due to the different combinations of cannabinoids but to the combination of these cannabinoids with the different terpenoids present in each variety. So being, the number of combinations between cannabinoids and terpenoids means that when we talk about medicinal cannabis we are not talking about just one type of “medicine”. Buy hemp online

This is where the main problem of dosing with cannabis lies … 5 mgs of THC administered by using a pure Sativa variety with a high concentration of the limping terpenoid, will never cause the same effects as 5 mgs of THC administered. using a pure Indica variety with a high concentration of the pinene terpenoid. That is why cannabis cannot be dosed like the rest of the drugs. To further curl the curl, to the above we must add the genetic variability of each individual since the same 5 mg of a variety will not produce the same effect applied to two different individuals, although the product is exactly the same. Buy CBD prerolls online

What is the only possible solution to this set of obstacles that arise when we want to dose cannabis?

Treatment Individualization

This means that each individual will have a dose that will be the one that best suits their health problem, and that will depend on the individual (previous experience with cannabis, concomitant medication being taken, type of metabolizer for THC …), of the product used (THC and CBD percentage, terpenoid content, variety with a certain Sativa / Indica ratio …) and the route used (oral, sublingual, vaporized …).

To find the appropriate dose for each individual, the protocol will always be the same: Start with low doses and gradually increase until you find the dose that improves the individual’s symptoms without the intensity of the side effects limiting therapeutic adherence to treatment, or that is, the one with the most efficient balance between improvement of symptoms/intensity of side effects. For this, it is important to invest enough time in finding this balance. Too rapid increases in doses will cause side effects that will often lead to the rejection of the treatment by the patient, while if the increase in the dose is excessively long in time, the lack of effectiveness will cause the patient to abandon the treatment before the apparent lack of effectiveness of the same. Buy marijuana online

For all the aforementioned, we can conclude that the cannabis treatment will always have an individualized dosage for each patient, which will be done starting with low doses to gradually increase and at an adequate rate until the optimal dose is found for each individual, taking into account note that this optimal dose will be defined by the balance between improvement of symptoms/tolerance to side effects by the patient and that it will also depend significantly on both the type of product and the route of administration used.

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