Potential medical benefits
CBD
Cannabidiol only
- Analgesic
- Anti-inflammatory
- Antiemetic
- Antispasmodic
- Anti-epileptic
- Anxiolytic
- Reduces THC-induced psychoactivity/anxiety
CBD:THC
Cannabidiol and tetrahydrocannabinol blends
- Analgesic
- Anti-inflammatory
- Antispasmodic
- Antiemetic
- Appetite stimulant
- Soporific
- Mood elevator
- Decreases intestinal motility
Likely beneficial for
CBD
Cannabidiol only
- Anxiety
- Depression
- Chronic pain
- Spasticity associated with MS, ALS and spinal cord injury
- Epilepsy
- Inflammation & inflammatory conditions, including IBS, ulcerative colitis, Crohn’s, fibromyalgia, rheumatoid arthritis
- PTSD
CBD:THC
Cannabidiol and tetrahydrocannabinol blends
- Chronic pain
- Nausea & vomiting
- Anorexia
- Spasticity associated with MS, ALS and spinal cord injury
- Inflammation & inflammatory conditions, including IBS, ulcerative colitis, Crohn’s, fibromyalgia, rheumatoid arthritis
- Limited evidence suggests that THC in particular may be beneficial for insomnia, neuropathic pain, nausea/vomiting and PTSD. It is recommended to start with CBD and introduce 1:1 in the evenings if needed for insomnia, PTSD, etc.
Potential side effects
CBD
Cannabidiol only
Cannabidiol exhibits biphasic properties –
most therapeutic effects are found at lower doses; slow titration may mitigate potential side effects.
- Somnolence, changes in appetite/weight
- In rare cases, may cause diarrhea
CBD:THC
Cannabidiol and tetrahydrocannabinol blends
Tetrahydrocannabinol exhibits biphasic properties – most therapeutic effects are found at lower doses; slow titration may mitigate potential side effects.
- Anxiety, disorientation, intoxication, somnolence
- May induce psychosis in susceptible individuals (personal or family history)
- In rare cases, may cause orthostatic hypotension, depression, ataxia/dyscoordination, tachycardia, cannabis hyperemesis, diarrhea
Contraindications
CBD
Cannabidiol only
- Unsuitable for pregnant and breastfeeding patients
CBD:THC
Cannabidiol and tetrahydrocannabinol blends
- Acute psychosis, severe/unstable psychiatric conditions, actively suicidal
- History of THC-induced hyperemesis
- Under age 25
- Severe cardiovascular, immunological, liver or kidney disease (especially in acute illness – can exacerbate arrhythmias)
- Caution should be exercised in patients with history of drug or alcohol addiction (although recent evidence points to cannabis as potential harm reduction substitution)
- Unsuitable for pregnant and breastfeeding patients
Drug interactions
CBD
Cannabidiol only
Many interactions can be mitigated in complex patients with polypharmacy by slowly titrating.
- CYP450 enzyme inhibitor
- May interact with anti-epileptic drugs; close monitoring of AED levels and LFTs advised
- Potent inhibitor of CYP3A4 and CYP2D6; may increase serum concentrations of macrolides, calcium channel blockers, benzodiazepines, cyclosporine, sildenafil (and other PDE5 inhibitors), antihistamines, haloperidol, antiretrovirals, and some statins (atorvastatin and simvastatin, but not pravastatin or rosuvastatin); may increase serum concentrations of SSRIs, tricyclic antidepressants, antipsychotics, beta blockers and opioids (including codeine and oxycodone)
CBD:THC
Cannabidiol and tetrahydrocannabinol blends
Many interactions can be mitigated in complex patients with polypharmacy by slowly titrating.
- CYP450 enzyme inhibitor
- CYP1A2 inducer (theoretically can decrease serum concentrations of clozapine, duloxetine, naproxen, cyclobenzaprine, olanzapine, haloperidol, and chlorpromazine)
- Potential interaction with medications metabolized by P450 enzymes (2C9, 2C19, 3A4), including antidepressants, proton pump inhibitors, cimetidine, macrolides, antimycotics, calcium antagonists, HIV protease inhibitors, amiodarone, isoniazid.
- The following drugs may decrease the availability of THC: carbamazepine, rifampicin, phenobarbital, phenytoin, primidone, rifabutin, St. John’s wort
Safety
CBD
Cannabidiol only
No reports of abuse or dependence; no public health risk.
CBD:THC
Cannabidiol and tetrahydrocannabinol blends
Minimal risk of dependence, similar to anxyolitics at 9%.
(Versus 21% for opioids, 23% for alcohol and 68% for tobacco.)
Dosing
CBD
Cannabidiol only
Oils & capsules/softgels
- Daytime dosing, no psychoactive effect
- b.i.d to t.i.d. dosing
- Start at 2.5mg/day
- Titrate by 2.5 mg q 2-3 days as tolerated
*Unless you wish otherwise, a Natural Care RN will create a personalized dosing and titration schedule for every patient, with regular telephone check-ins and follow-up, at no charge.
CBD:THC
Cannabidiol and tetrahydrocannabinol blends
Oils & capsules/softgels
- Nighttime dosing, mild psychoactive, sedating effects
- At hs only to start
- Start at 2.5 mg, titrate by 1mg q 2-3 days as tolerated and to desired effect
*Unless you wish otherwise, a Natural Care RN will create a personalized dosing and titration schedule for every patient, with regular telephone check-ins and follow-up, at no charge.
Product
INHALATION
Flower, a.k.a. bud
ORAL INGESTION
Oils, capsules, softgels
Onset
INHALATION
Less than 5 min
ORAL INGESTION
30 min to 2 hrs
Peak effect
INHALATION
Less than 15 min
ORAL INGESTION
2 to 4 hrs
Duration
INHALATION
2 to 4 hrs
ORAL INGESTION
4 to 8 hrs
Notes
INHALATION
Ingestion methods are generally preferred for consistent dosing and longer impact. Some patients may desire inhalation for acute and breakout pain.
Vapourizing recommended
(not smoking).
ORAL INGESTION
Oils
Administered sublingually, swallowed or mixed with food.
Capsules & softgels
Ingested as usual.
Driving after cannabis use
INHALATION
Patients should be counselled not to drive for 4 hours after inhalation, or for 8 hours if euphoria is experienced.
ORAL INGESTION
Patients should be counselled not to drive for 6 hours after ingestion, or for 8 hours if euphoria is experienced.
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