CBD dosing for Therapeutic Application

Medical cannabis may have broad therapeutic potential which is mainly attributed to the presence of phytocannabinoids. The most notable cannabinoids are tetrahydrocannabinol (THC), which possesses the typical psychoactive effects, and cannabidiol (CBD) which is a non-psychoactive substance. According to recent studies, CBD has a wide of therapeutic applications for relieving pain, anxiety, insomnia, and more.

In this article, we will review expert recommendations about how to dose CBD products safely and effectively. We will discuss the differences in the effectiveness and bioavailability of different CBD products. Read on to find out all about the science of CBD dosing.

CBD Dosage: How Much to Take According to Experts?

One of the best recommendations from researchers and experts on CBD therapy was published last year in the reputable journal Annals of Internal Medicine. (1) According to the experts, CBD has significant therapeutic potential for various conditions including pain and anxiety. However, the authors noted specific things to look out for when choosing the correct product and dosage in order to ensure safety and effectiveness.

First of all, make sure to pick natural hemp-derived products with detailed information on the manufacturer and ingredients used. It’s also recommended to select products that are verified for their safety and potency by third-party lab testing. Unfortunately, there have been cases of products labeled as CBD which contain 4-CCB instead – a synthetic cannabinoid that can lead to acute poisoning in humans. According to the CDC, there were 52 cases of 4-CCB poisoning in Utah caused by such mislabeled products, the manufacturers were not specified. (2)

You should “start-low and go-slow” with the dosing. According to the researchers, you should start as low as 5 to 10mg taken twice daily. This is what most products offer as the amount of CBD per dose according to directions on the container. Then you should slowly increase the dosage until you achieve the desired effect. This usually happens after 4-6 weeks and around a dose range of 50mg to 100mg of CBD taken twice daily.

If CBD extract alone provides insufficient relief, researchers suggest adding 1.0 to 2.5 mg of THC and slowly titrating up if needed. The most common CBD products are either CBD alone or CBD along with THC at ratios of 1:1 or 4:1. Ratios such as 20:1 are rarer but they might be worth trying since a tiny bit of THC might enhance CBD’s activation and consequent therapeutic potential while still avoiding possible adverse effects of the psychoactive compound.

If you have low blood pressure (BP), you should be even more cautious when titrating your dosage as you might experience a drop in BP initially. A study in 26 males given either a placebo or CBD dosage of 600mg daily showed a reduction in BP but the effect was lost after seven days of treatment due to the development of tolerance. (3)

Experts recommend choosing a broad-spectrum CBD oil which also contains cannabis plant terpenoids or terpenes. (4) Terpenoids in cannabis such as myrcene and pinene are the essential oils contributing to the smell and taste of the product, but some of them can potentially increase the potential health benefits as well.

CBD Edibles

CBD oral products are generally well tolerated. Usually, they are in the form of capsules or edibles. Studies show that the safety and the pharmacokinetic profile of CBD taken orally supports the recommendation of taking it twice daily for maximum benefit. (5) According to the research, CBD’s effective half-life ranged from 10 to 17 hours. Furthermore, the terminal elimination half-life of CBD after oral use is approximately 60 hours after 750 mg to 1500 mg CBD taken twice daily.

However, it takes hours for the compound’s effects to occur and you get only a maximum of 20% of the total dose taken into your bloodstream. (6) That is because oral use has a first-pass metabolism which means CBD goes through the liver first where a large portion of it breaks down as it is metabolized by a pathway of hepatic enzymes. (7)

If you use CBD in the oral form, make sure to take it with a high-fat meal because according to trials, doing so leads to increased CBD plasma levels and therefore better bioavailability. Bioavailability describes how much of the product used will enter your bloodstream.

Mucosal and Sublingual CBD Products

There are sublingual and buccal products that absorb through the mucosa in your mouth which is highly vascularized. This bypasses the first-pass metabolism of the liver and significantly increases the bioavailability of the CBD product. (8) Furthermore, the onset of CBD’s effect is much quicker when used this way. Buccal and sublingual products are usually in the form of tinctures or sprays and contain fewer additives compared to edibles. Oromucosal sprays have up to 35% bioavailability while for the sublingual application it's even higher. (9) Oral formulations (such as capsules) are best for long-term symptom relief and tinctures/sprays can be used for breakthrough symptoms.

CBD Topicals

The topical use of CBD is also not subjected to the first-pass effect. Such products are creams, lotions, balms, and skin patches. However, your skin is not as permeable as your mucosal membranes so picking a cream with low CBD content might prove to be ineffective. It is also much harder to estimate the exact bioavailability of the product applied to the skin.

Nevertheless, transdermal CBD application in animal studies has been effective in reducing inflammation and pain-related behavior due to arthritis. (10) Transdermal CBD gel significantly reduced joint swelling, pain, and immune cell infiltration in a dose‐dependent manner.

Inhaling CBD Products

If you prefer to inhale cannabinoids then vaping is probably the better choice as it has fewer adverse effects than actual smoking. This route of administration also bypasses the liver. Bioavailability after smoking has been reported to be up to 50%. (6) The effects occur in less than 10 minutes.

Smoking is not recommended as it exposes your lungs to many carcinogens as well as hot gases from combusting the material. Vaping might be a safer option, even though the evidence on its safety is still rather conflicting.

You have to be very careful when choosing vape cartridges if you have decided to inhale your CBD. According to a literature review published in the American Journal of Physiology, certain

carriers and thinning agents such as vegetable glycerin, coconut oil, or propylene glycol can cause serious harm to the lungs. (11)

Is It Possible to Take Too Much CBD?

We must note that certain individuals might require higher doses of CBD to achieve the desired therapeutic effects such as adequate pain relief, reduced anxiety, improved mood, and better sleep. A large systematic review of CBD dosing in clinical populations has looked at 1038 articles and picked from these 35 higher-quality ones which involved CBD dosing of anywhere between 1 to 50 mg/kg/d. (12) 11 studies have demonstrated the positive effects of CBD on epilepsy at an average dose of 15mg/kg/d. Some of the studies investigated other conditions as well but found no benefits at an average dose of 2.4 mg/kg/d. They suggested 15mg/kg/d for a person who weighs 165lbs. This is over 1,000mg of daily CBD dosage which seems quite high. There are concerns raised by the FDA that such high doses of CBD might lead to liver damage. This opinion is mostly based on an animal study where mice were given extremely high doses of CBD derived from cannabis extract, much higher than 15mg/kg/d (13) More studies are needed to evaluate the exact risk and to estimate the human equivalent.

In contrast, multiple studies and case reports in humans show good tolerance of doses up to 1,500 mg per day. For example, there are a total of 6 case reports by Zuardi et al. who tested CBD doses of 1,000 to 1,500 mg/day for up to 4 weeks on 3 different psychological conditions. (14, 15, 16) While CBD was ineffective for treating bipolar disorder and schizophrenia, it was well tolerated and had no side effects amongst any of the patients.

There was also a randomized control trial with 42 patients with schizophrenia who took either up to 800mg CBD or antipsychotic daily for 4 weeks. (17) Only 3 patients from the CBD group had to reduce their dosage due to side effects. None of the side-effects were serious, as they mostly included diarrhea, nausea, headaches, and somnolence.

Furthermore, according to the WHO report from 2018, CBD has a generally favorable safety profile and low potential for abuse. (18) However, we need more studies to estimate the exact dose ranges that are both well tolerated and effective.

In conclusion

Much more research is needed to evaluate CBD safety and its full therapeutic potential. So far, research seems promising about the effects of CBD on seizures, pain, anxiety, appetite, sleep, and overall mood.

Despite concerns from animal studies, CBD seems to be well tolerated by most people when used in reasonable doses. CBD has low abuse potential and is rarely associated with side effects which seem to be mild when the do occur; headaches, diarrhea, and nausea. A lot of exciting research is coming which will reveal more about CBDs wide spectrum of effects.

References:

1. https://pubmed.ncbi.nlm.nih.gov/30615778/
2. https://www.cdc.gov/mmwr/volumes/67/wr/mm6720a5.htm
3. https://bpspubs.onlinelibrary.wiley.com/doi/abs/10.1111/bcp.14225
4. https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/j.1476-5381.2011.01238.x
5. https://link.springer.com/article/10.1007/s40263-018-0578-5
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689518/
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6222489/
8. https://link.springer.com/article/10.2165/00003088-200241090-00003
9. https://pubmed.ncbi.nlm.nih.gov/22716155/
10. https://onlinelibrary.wiley.com/doi/10.1002/ejp.818
11. https://journals.physiology.org/doi/full/10.1152/ajplung.00071.2017
12. https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bcp.14038
13. https://www.mdpi.com/1420-3049/24/9/1694/htm)
14. https://pubmed.ncbi.nlm.nih.gov/7559378/
15. https://pubmed.ncbi.nlm.nih.gov/16401651/
16. https://pubmed.ncbi.nlm.nih.gov/18801823/
17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3316151/
18. https://www.who.int/docs/default-source/controlled-substances/whocbdreportmay2018-2.pdf?sfvrsn=f78db177_2