• 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

• 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.

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

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

• Unsuitable for pregnant and breastfeeding patients

• 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

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)

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

No reports of abuse or dependence; no public health risk.

Minimal risk of dependence, similar to anxyolitics at 9%.
(Versus 21% for opioids, 23% for alcohol and 68% for tobacco.)

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.

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.