What is the recommended dosing of Cannabidiol (CBD) for epilepsy?

From the Guidelines

Cannabidiol (CBD) dosing for epilepsy should start at 2.5 mg/kg taken twice daily (5 mg/kg/day total) and can be gradually increased to 5-10 mg/kg twice daily (10-20 mg/kg/day total) based on response and tolerability, as recommended by the FDA-approved Epidiolex regimen 1. The dosing of CBD for epilepsy is crucial to minimize side effects and maximize efficacy.

• The maximum recommended dose is 20 mg/kg/day, though some patients may require up to 25 mg/kg/day in refractory cases.
• Dosing should be individualized with careful titration over 2-4 weeks to minimize side effects like sedation, diarrhea, and elevated liver enzymes.
• CBD works by modulating multiple neuronal pathways including TRPV1 receptors and GPR55, reducing neuronal hyperexcitability without directly affecting cannabinoid receptors.
• It's particularly effective for Dravet syndrome, Lennox-Gastaut syndrome, and tuberous sclerosis complex, as approved by the FDA in 2018 and 2020 1.
• Patients should take CBD with food to improve absorption, maintain consistent timing between doses, and have regular liver function monitoring, especially when used with valproate or clobazam which have known drug interactions.
• Treatment response should be assessed after 8-12 weeks at a stable dose before determining effectiveness, as this allows for adequate evaluation of the medication's efficacy and safety profile 1.

From the Research

Recommended Dosing of Cannabidiol (CBD) for Epilepsy

• The recommended dosing of CBD for epilepsy varies depending on the specific condition and patient population.
• According to the study by 2, patients with Lennox-Gastaut syndrome (LGS) or Dravet syndrome (DS) received a pharmaceutical formulation of highly purified CBD in oral solution at 2-10 mg/kg/day, titrated until tolerability limit or a maximum dose of 25-50 mg/kg/day.
• The study by 3 used a dose of 20 mg/kg oral CBD daily for 14 weeks in patients with treatment-resistant LGS.
• The study by 4 used a dose of 2.5 to 20 mg/kg/d, titrated over a 2-week period, with a mean modal dose of 21 mg/kg/d.

Dosing Ranges

• The dosing range for CBD in epilepsy patients is typically between 2-50 mg/kg/day, with some studies using a fixed dose of 20 mg/kg/day.
• The study by 5 used a maximum dose of 25 mg/kg per day.
• The study by 4 allowed for dose reductions or increases up to 30 mg/kg/d based on response and tolerance.

Key Findings

• The studies by 2, 3, and 4 demonstrate the efficacy and safety of CBD in reducing seizure frequency in patients with LGS and DS.
• The most common adverse events reported in these studies were somnolence, diarrhea, and decreased appetite.
• The study by 4 showed that long-term CBD treatment had an acceptable safety profile and led to sustained, clinically meaningful reductions in seizure frequency in patients with treatment-resistant DS.