Introduction

Hemp-derived cannabidiol (CBD) is still relatively new, so standards for dosing and prescribing have not been universally established. In fact, the FDA has yet to establish an RDI for CBD, meaning it does not have an official serving size.

Considering CBD acts as an antagonist of CB1 receptors and at higher doses can saturate these receptors and act on numerous other receptors on the body, the general consensus with CBD dosing is to “Start Low and Go Slow”. By following this, the ideal dosing level can be established for each individual patient.

Dosing Considerations

To date, no fatalities with phytocannabinoid use, CBD have been reported. The general consensus is that chronic use of CBD specifically is well-tolerated in humans, with doses up to 1,500 mg/day considered safe. (REF)

When prescribing oral hemp-derived CBD, some basic guidelines can be taken into consideration. Typical standard dosing of CBD extracts starts at 10mg or 1ml per day, depending on extraction and equivalency. Some products will allow for micro-dosing at 2.5 to 5 mg, which may be advised based on what other medications and supplements a patient is taking.

Standard dosing has not been established for cannabidiol, regardless of condition. However, early research and reviews are revealing suggested dosing for a select number of conditions.

Insomnia – 160mg per day (REF)

Social Anxiety Disorder – 400-600mg per day (REFREF)

Arthritic Pain – no dosing guidelines exist, but animal trials are pointing to 25mg/kg as an effective starting dose (REFREFREFREF)

Treatment-Resistant Epilepsy in Pediatric Population – 10 to 20 mg/kg/day (REF)

  • Note: current clinical trials demonstrating the effectiveness of CBD in treating children with Dravet Syndrome (DS) and Lennox-Gastaut Syndrome (LGS) only applies to Epidiolex, an FDA-approved pharmaceutical extract of CBD. There is no current research using non-standardized CBD extracts in TRE.

 

Clinicians: if you are using these guidelines, you are reminded that you do so at your own risk/discretion. These guidelines are intended to act as a review of existing clinical research on cannabidiol dosing recommendations. As clinical trials are released and dosing guidelines are updated, we will periodically update this section.

Additionally, if you would like to submit an article that provides context for dosing recommendations, please send it to our Integrative Medical Advisory team for review via medical@naturalpartners.com.

Last Updated: January 25, 2019

CBD Safety

Numerous small studies of CBD safety have been conducted and the current conclusion is that an upper tolerable limit has not been established. To date, no significant central nervous system, vital sign or mood side effects have been observed at doses of up to 1500 mg/day (oral) or 30 mg (intravenous) in both acute and chronic administration. (REF)

Based on in vitro observation of Interleukin 8 and 10 inhibition and lymphocyte apoptosis, there may be some theoretical risk of immunosuppression. (REF)

Long-term trials have not been established, so practitioners are cautioned to restrict long-term of use of cannabidiol-containing products to a limited period.

General Patient Recommendations

  • Start Low. Go Slow.
  • CBD oils are slow-acting and long-lasting. Consume slowly and deliberately.
  • There are no reported cases of lethality and CBD has minimal reported side effects, but beware of potential side effects at doses higher than 500mg per day.
  • Always note the equivalency factor in dosing to calculate the quantity of mg being consumed per dose.
  • Sublingual consumption is faster-acting that oral consumption.
  • Drowsiness from CBD use is unlikely, but due to the varied effect per person, patients are encouraged to consume CBD-containing products in a safe and comfortable environment, at least for the first few weeks of use.

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