Cannabidiol Use in Refractory Epilepsy

Marcia L. Buck, PharmD, FCCP, FPPAG, BCPPS


Pediatr Pharm. 2018;24(11) 

In This Article

Dosing Recommendations

The recommended dose for CBD initiation is 2.5 mg/kg given orally twice daily (5 mg/kg/day).[2] After one week, the dose can be increased to the typical maintenance dose of 10 mg/kg/day. In patients not responding to 10 mg/kg/day, the dose may be increased weekly by increments of 2.5 mg/kg/day to a maximum of 20 mg/kg/day. If a more rapid escalation is necessary, the titration from 10 mg/kg/day to 20 mg/kg/day may be made with by increasing the dose every other day. Doses should be given at consistent times, with or without food. If discontinuation of CBD is necessary, it should be done gradually over several weeks to minimize the risk for increased seizure frequency or status epilepticus.

Cannabidiol doses should be reduced in patients with moderate or severe hepatic impairment (Child-Pugh classes B or C).[2] In moderate impairment, the manufacturer recommends an initial dose of 1.25 mg/kg twice daily, with a maximum dose of 5 mg/kg twice daily. Patients with severe hepatic impairment should begin therapy with a dose of 0.5 mg/kg twice daily, increasing to a maximum dose of 2 mg/kg twice daily. Dose titration may also be slowed from weekly to every two weeks to allow a greater period for assessment before dose escalation.