About
Cannabidiol (medical cannabis) is an antiseizure medication that is formed of pure CBD. The psychoactive component, tetrahydrocannabinoid (THC) has been removed.
Cannabidiol is usually used as an adjunctive therapy to control focal and generalised seizures in children with Dravet syndrome, Lennox Gastaut Syndrome and Tuberose Sclerosis Complex.
Currently, cannabdiol as Epidyolex has been approved on the PBS and prescribed for children with Dravet’s syndrome.
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Side effects
Possible side effects
- Sleepiness / drowsiness
- Irritability, changes in mood and behaviour
- Fatigue / lack of energy
- Changes in appetite (increased or decreased)
- Diarrhoea and/or vomiting
- Fever
- Upper respiratory tract infection
- Drooling
- Increased seizures
- Cannabidiol may also cause side effects if it interacts with other medicines (see interactions tab).
- All anticonvulsants are potentially teratogenic and this is often dose related (see section: AED Prescribing - Pregnancy)
Other notable side effects
- Cannabidiol can cause liver dysfunction and liver enzymes should be monitored prior to start of treatment and with titration.
Dosing
- The below initiation and escalation doses are only a guide and need to be individualised based on patient (age, weight, co-morbidities), disease (seizure type, frequency, duration) and medication (metabolism, interactions, side-effect profile) characteristics.
- Situations that require more careful consideration include children with higher weights, polytherapy, or multiple co-morbidities. Consultation with appropriate formularies or a paediatric neurologist may be required in specific circumstances.
- Dosing regimes can be used for children up to weights of 40kg.
- Administration should be in two equally divided doses.
- Initially 5mg/kg/day in two divided doses for one week then increase to a maintenance dose of 10mg/kg/day.
- Higher doses to 20mg/kg/day may be used (with increments of 5mg/kg/day weekly) with consultation of a paediatric neurologist.
- When discontinuing, withdraw very slowly. Sudden cessation of cannabidiol can cause seizures. The withdrawal plan is dependent on total daily dosage and duration of treatment but should be done very gradually.
Preparations:
- Syrup: 100mg/ml
Interactions | Precautions
- Cannabidiol may interact with other medications including antiseizure medications such as clobazam, sodium valproate and phenytoin.
Information last reviewed: 9/6/2023.