Your Dose of Cannabis Education
Your Dose of Cannabis Education
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Your Dose of Cannabis Education is based on data from the studies and reviews published in the current peer-reviewed medical journals. Whether you are a healthcare provider, patient, caregiver, an individual working in the healthcare sector, or just a curious person, you can benefit from Your Dose of Cannabis Education.
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2025-07-09
Should the cannabinoid dosing regimen be adjusted for a patient with renal insufficiency?
After being metabolized by the liver, cannabinoids are excreted through the GI tract and kidney. One of the key points of the European Pain Federation position paper is Consider a lower starting dose in patients with renal and hepatic insufficiency.Huser, W, Finn, DP, Kalso, E, et al. European Pain Federation (EFIC) position paper on appropriate use of cannabis_based medicines and medical cannabis for chronic pain management. Eur J Pain.. 2018; 22: 1547Đ 1564. https://pubmed.ncbi.nlm.nih.gov/30074291/ Grotenhermen F. Clinical pharmacokinetics of cannabinoids. J Cannabis Ther, 2003; 3(1): 3-51. https://www.tandfonline.com/doi/abs/10.1300/J175v03n01_02
2025-07-08
Should the dosing regimen of cannabinoid-based products be altered for patients with hepatic insufficiency?
Cannabinoids are metabolized by the liver and excreted through the GI tract and kidney. When considering cannabinoid-based products for patients with severe liver impairment, the dosage of the cannabinoid-based products may need to be adjusted. For example, according to the prescribing information for an FDA-approved cannabidiol product, patients with hepatic impairment require dosage adjustment. A slower dose titration in patients with moderate or severe hepatic impairment than in patients without hepatic impairment is recommended.Highlights for prescribing information for Epidiolex. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210365lbl.pdf
2025-07-07
Compared to younger adults, are elderly patients more or less sensitive to the pharmacological effects of cannabinoids?
In general, there is a greater frequency of decreased hepatic, renal, and/or cardiac function in the elderly population compared to younger populations. Also, concomitant disease and other drug therapy is more common in the elderly population, and elderly patients typically metabolize drugs more slowly. As a result of all of these factors, elderly patients are affected by cannabinoids differently than the younger populations are affected. According to the drug monographs of cannabinoid medications approved by the Medicines and Healthcare Products Regulatory Agency in the UK, Health Canada and/or the US Food and Drug Administration, elderly patients may be more sensitive to the psychoactive and neurologic side effects of cannabinoids compared to younger adults. Also, elderly patients may be more sensitive to the hypotensive effects of cannabinoids. FDA Product data for nabilone for oral administration https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/018677s011lbl.pdf accessed 12/24/18
Hughes SG. Prescribing for the elderly patient: why do we need to exercise caution? Br J Clin Pharmacol. 1998;46(6):531-3.
Lloyd SL, Striley CW. Marijuana Use Among Adults 50 Years or Older in the 21st Century. Gerontol Geriatr Med. 2018;4:2333721418781668. Published 2018 Jun 21.
Valeant Canada. Cesamet Product Monograph. 2009. - https://pdf.hres.ca/dpd_pm/00007760.PDF
Abbott Products Inc. Marinol product Monograph. 2010 - https://pdf.hres.ca/dpd_pm/00013378.PDF
GW Pharmaceuticals. Sativex Product Monograph. 2013. - https://pdf.hres.ca/dpd_pm/00016162.PDF
2025-07-03
Are there any dosing considerations for recommending/prescribing cannabinoid-based medicines for patients utilizing high doses of opioids or benzodiazepines?
According to the European Pain Federation position paper on appropriate use of cannabis-based medicines and medical cannabis for chronic pain management, in the absence of available literature, it is the panel expert opinion that cannabis use could worsen the cognitive impairment caused by high doses of opioids and benzodiazepines. If cannabis is prescribed, it should be prescribed at a low dose and should be discontinued if it affects patients' memory, mood or function. Physicians should consider tapering high opioid (ł90 mg morphine equivalent/day) or benzodiazepine doses, especially in patients with chronic noncancer pain.
A key point from that position paper is: Do not prescribe cannabis_based medicines to patients taking high doses of opioids or benzodiazepines.Huser, W, Finn, DP, Kalso, E, et al. European Pain Federation (EFIC) position paper on appropriate use of cannabis_based medicines and medical cannabis for chronic pain management. Eur J Pain.. 2018; 22: 1547Đ 1564. https://pubmed.ncbi.nlm.nih.gov/30074291/
2025-07-02
How should the cannabinoid-based therapy be withdrawn?
According to the Health Canada document entitled "Information for Health Care Professionals Đ Cannabis (marihuana, marijuana) and the Cannabinoids," If intolerable adverse effects appear without significant benefit, dosing should be tapered and stopped. Tapering guidelines have not been published, but the existence of a withdrawal syndrome suggests that tapering should be done slowly (i.e. over several days or weeks). Note: When discontinuing cannabidiol therapies used for the treatment of seizure disorders, the dose should be decreased gradually. As with all antiepileptic drugs, abrupt discontinuation should be avoided when possible, to minimize the potential risk of increased seizure frequency and status epilepticus.Information for Health Care Professionals Đ Cannabis (marihuana, marijuana) and the Cannabinoids Đ Dried or fresh plant and oil for administration by ingestion or other means Psychoactive agent. This document can be found at https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids-eng.pdf
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