Evidence-based starting doses, titration schedules, and maximum doses by condition and formulation. All protocols derived from peer-reviewed clinical trials.
THC:CBD 1:1 (Nabiximols / Sativex) · Oromucosal spray
Spray under tongue or on inner cheek. Hold 60 seconds before swallowing. Avoid eating/drinking 15 min before/after.
THC:CBD 1:1 (Nabiximols) · Oromucosal spray
Adjunct to existing opioid regimen. Monitor for additive CNS depression. Do not replace opioids abruptly.
For clinicians, pharmacists, and healthcare researchers
Unlock all 12 condition-specific dosing protocols with starting doses, titration schedules, maximum doses, route comparisons, and pediatric vs. adult guidance — all derived from peer-reviewed clinical trials.
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| Route | Onset | Peak | Duration | Bioavailability | Notes |
|---|---|---|---|---|---|
| Inhalation (Vaporized) | 5–15 min | 15–30 min | 2–3 hours | 10–35% | Fastest onset. Respiratory risks. Not recommended for medical use in most guidelines. |
| Sublingual / Oromucosal | 15–45 min | 45–90 min | 4–6 hours | 13–35% | Bypasses first-pass metabolism. More consistent than oral. Preferred for medical use. |
| Oral (Capsule/Oil with food) | 30–120 min | 2–4 hours | 6–8 hours | 6–20% (higher with fat) | Most variable. High-fat meal increases CBD bioavailability ~5x. Longest duration. |
| Topical | 30–60 min | 1–2 hours | 4–6 hours | <1% systemic | Minimal systemic absorption. Suitable for localized pain/inflammation. No psychoactive effects. |
Begin at the lowest effective dose and titrate upward over weeks, not days. Rapid titration increases adverse effects without improving efficacy.
Cannabinoid response varies significantly by genetics (CYP polymorphisms), body composition, prior exposure, and endocannabinoid tone. Expect wide inter-individual variation.
Tolerance to THC's effects develops within 2–4 weeks of daily use. If efficacy diminishes, consider a 2-week drug holiday before dose escalation.
For patients on chronic THC therapy, a planned 2-week abstinence period every 3–6 months can restore receptor sensitivity and reduce required doses.
Pharmaceutical-grade formulations (Epidiolex, Sativex, Dronabinol) have established pharmacokinetics. Artisanal products have variable potency — treat as unknown dose.
Reassess therapeutic benefit and adverse effects at 4–6 weeks. Discontinue if no meaningful benefit. Document outcomes systematically.
