Understanding How CBD and Cannabinoid Products Work to Determine Dosing Strategies

cbd dosing and microdosing strategies


Introduction

Cannabidiol (CBD) and cannabinoids are the chief compounds found in the Cannabis plant, which is also known as hemp when the variety has low levels of THC.  CBD is available globally through many retailers as a food supplement and also as a medical grade prescription drug.

A medicine has been approved as a form of CBD commonly used in the United States (US) and the UK for the treatment of seizures as per prescription. The use of CBD and cannabinoid products as prescription medicines has also been extended to treat pain, anxiety, Crohn's disease, muscle disorder, Parkinson's disease, and other critical health conditions (WebMed, 2021) (1).

US Food and Drug Administration (FDA, 2021) highlights the potential opportunities encompassed by these products. On the other hand, to regulate the marketing of such products, the Federal Food, Drug, and Cosmetic Act (FD&C Act) is implemented, which mainly ensures the safety and health of consumers by minimizing risks (FDA, 2021) (2). In this regard, this article explores the use of CBD and cannabinoid products for determining dosage strategies.

Additionally, the article also addresses the interaction of CBD with the body utilizing the endocannabinoid system (ECS), which is followed by a description of different factors that could alter the dosage.      

How Consuming CBD Interacts with the Body through the ECS

Endocannabinoids or endogenous cannabinoids are made naturally in the human body, which are similar to cannabinoids. Endocannabinoids bind to the receptors found in the body, which sends a signal to the ECS to take action. The two major endocannabinoid receptors are CB1 in the central nervous system and CB2 in the peripheral nervous system (Bow & Rimoldi, 2016) (3).

Tetrahydrocannabinol (THC) is a major cannabinoid found in cannabis. When in the body, it binds with the CB1 and CB2 receptors. On the other hand, cannabidiol (CBD) is the other major component of cannabis. The exact reason for the interaction between CBD and ECS is still unknown. However, several researchers have stated that CBD works by preventing the endocannabinoids from breaking down into small particles modulating psychoactive effects (Carter, 2019) (4).

Factors That May Alter the Dosage on An Individual Basis

Several factors might affect the dosage a person takes similar to other medications. Based on the physical health or medical condition of a person, the dosage of CBD is modified considering the reason for taking it. For example, a smaller dose of CBD is sufficient for treating anxiety whereas a high dose is given for epilepsy. Another major factor that is considered when giving medications or supplements generally is weight.

Arzimanoglou et al. (2020) (5) in a study stated that the dosage of CBD is calculated based on the weight of epilepsy patients, meaning that lower dose for underweight individuals. In general, age affects the dose of medication as children and adults are given different doses (Zakharov et al., 2012) (6).

This might be applicable to the case of the CBD regime. Santos-Longhurst (2019a) (7)  stated that the water content in the body, metabolism speed, and body mass index affect the duration of CBD in the system, indicating that these factors might be considered when prescribing doses.

Additionally, the form of CBD also affects the dosage because of the difference in volumes. For example, CBD tinctures and oils contain 1 mg CBD per drop whereas the dose in CBD gummies is 5 mg per gummy (Santos-Longhurst, 2019b) (8).

Alcohol and other depressants might elevate the sedative effect of CBD, thereby such people who are alcoholic or use other medications with drowsiness effects must lower the dose of CBD or avoid it.

Intended Conditions That May Affect Dosing Regime

Different conditions require different dosing regimens as the form of CBD would be according to the specific condition. For instance, in skin problems such as eczema and acne, topical CBD (Maghfour et al., 2020) (9) as well as oral medication can be provided based on the severity of the condition.

Similarly, inflammation and pain on an external body part can also be treated with the help of an appropriate dose of topical medication whereas mood can be improved through oral or a vape dosage of CBD.

Understanding How CBD Products Work to Determine the Best Time to Take Dose

Sublingual CBD Oil / Spray

In this form, CBD oil drops are placed under the tongue to let them dissolve in the blood via tongue tissues, sending it to the CB1 and CB2 receptors in a short time. It is a common and effective way to administer CBD (Talley, n.d.) (10).

Ingesting CBD Oil

Peters and Chien (2018) (11) highlighted that the ingestion takes a bit longer to kick in as compared to the sublingual method because it takes a route through the digestive system. Hence, it takes about 45 minutes for the CBD to enter the bloodstream and for any effects to start showing.

High Bioavailable Water-Soluble CBD Drops

The absorption rate of water-soluble CBD drops is significantly higher than the ingestion of oil-based CBD compounds. This is because our body is majorly based on water content, thereby it is easier for water-soluble drops to be more bioavailable.

Vaping CBD

Vaping is a fast acting method to feel the effects of CBD, also the quickest to leave the system. When a person vapes CBD, it enters the lungs and takes quick affect on the individual.

Smoking CBD Herb

Similar to vaping, smoking CBD flower also promotes the absorption of CBD compounds through the lungs, from where it enters the bloodstream quickly and circulates throughout the body.

Applying CBD Topicals

When CBD is topically applied, it absorbs in the skin but does not enter the bloodstream due to the thickness of the skin.

Ingesting CBD Edibles (Capsules, gummies, tablets, chocolates, etc)

CBD edibles take a longer time (like 1.5 to 2 hours) to kick in because they are absorbed via the digestive tract. Thus, they also take a longer time to leave the system.

CBD Drinks

CBD drinks are water-based, so they are absorbed easily through the body. People can start to experience the effect of CBD drinks after 20 minutes or so.

CBD Patches

CBD patches quickly deliver Cannabidiol to the bloodstream surrounding the local area of the patch. This transdermal method works because of the presence of permeation enhancers in the patches (Drury, 2019) (12).

How To Understand the Amount CBD (Cannabidiol) % In A CBD Oil Bottle?

CBD bottles are available in many different volume sizes, such as: 100 ml, 30 ml, and 15 ml. To understand the amount of CBD in a product, CBD in milligrams must be calculated. The bottles usually have a CBD percentage and bottle size in ml written on it and the first step is to understand the relationship between millilitre and milligrams.

1 millilitre = 1 gram = 1000 milligrams

Now, to calculate the milligrams of Cannabidiol in a CBD oil, the formula is:

(Bottle Size (ml) x CBD Percentage (%)) × 1000 = CBD concentration in milligrams

For example, if a bottle of 15 ml has 5% CBD concentration, a 30 ml bottle has 5% CBD concentration and a 60 ml bottle has 5% CBD. Then:

15 ml: 15ml × 0.05 × 1000 = 750 mg CBD

30 ml: 30ml × 0.05 × 1000 = 1500 mg CBD

60ml: 60ml × 0.05 × 1000 = 3000 mg CBD

This shows the larger the bottle size, the greater the amount of CBD at the same percentage compared to a smaller bottle size.

How Doctors Prescribe CBD Oil and Dosage in a Medical Setting?

As per the FDA, Epidiolex is the only approved cannabis-derived product, which is available through prescription in the USA. The product is used for the treatment of seizures in individuals with severe epilepsy types termed Dravet syndrome and Lennox-Gastaut syndrome (Caporuscio, 2020) (13).

Therefore, Epidiolex is prescribed in the form of CBD oil with the starting dosage of twice a day 2.5 mg/kg of body weight, 5 mg/kg as the total dose each day. Dosage may increase after a week leading to 10 mg/kg per day (Caporuscio, 2020) (13).

However, outside of the US, the drug Sativex (Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD)) is also available through a doctors prescriptions for the treatment of MS spasticity.  Dosing under the guidance of a medical professional is advised on a gradually dose increase until the desired effect is obtained. 

In other conditions, the doctor also considers the factors that have been highlighted in earlier sections, to set the dose for CBD oil before prescribing it.

CBD Half-life and Dosing Regime

As highlighted above, there are different forms of administering CBD, which affects the time taken by CBD to kick in and stay in the system. This means that the half-life of CBD depends on the form of CBD. For example, the half-life of CBD is one to two days when it is taken orally, as proposed by Welty et al. (2014) (14).

In contrast, the half-life of vapes or smoke of CBD is just a few hours, which is quite shorter than the ingestion method. Hence, users should consider the half-life and the route of administration of CBD. The manufacturers recommend taking doses in multiple stages per day to make sure that the level of CBD in the blood remains stable, which is the concept behind microdosing also. If a person takes a large dose once a day, it cannot remain stable in the blood long enough until the next dose the following day. 

What Is CBD Microdosing and Its Benefits?

Micro-dosing means taking small doses of CBD throughout the day instead of taking a large dose in the morning. A single large dose would be effective in the morning and noontime but when the effect wears off in the evening, one cannot take another dose as the maximum recommended amount may have been already reached. In micro-dosing, a smaller amount of CBD is being taken throughout the day that maintains the level of CBD in the body helping to treat the problem (Evans, 2020) (15).

For instance, if a person is taking it for pain relief, they can feel CBD’s effect throughout the day as they are taking frequent small doses, which suppresses the pain for the day. Hence, it has been found that micro dosing is more beneficial due to its regulating property.

How To Implement Your Dosing Regime

dosing

Every person reacts differently to a dosage of Cannabidiol and it takes time to adjust the dose, to suite an individuals needs. It is advised to consult a physician before starting any CBD regimen as they will help you in calculating the dose based on the factors such as age, weight, physical health, etc.

However, if you are personally starting to use CBD without prescription as a food supplement, it is recommended to use the go steady and start low approach. In this way, you will start with a very low dose and slowly increase it to get the dosage, which is optimum for your needs. Nickel (2018) (16) also advised professionals to start off with this approach and slowly increase the dose to get the correct dose for every patient.

CBD Combination Product Dosing

As you know now, different forms of CBD take different times to have an effect on the body. A combination of different forms of CBD products can be used to assist users. For example, if a person requires immediate relief, CBD vapes can be administered to them and in conjunction with oral CBD can be prescribed for long-term treatment,

Common Cannabidiol Warnings and Potential Drug Interactions

Warnings

Common cannabidiol warnings are:

  • Pregnant and breastfeeding women cannot take CBD, as it can be harmful to the fetus or child (Knopf, 2020) (17).
  • For children over 1 year, Epidiolex has been found to be safe to use but other forms of CBD cannot be used as they are not studied and approved.
  • People with Parkinson's disease have been found to be negatively affected by CBD.
  • People with liver conditions need to take lower doses of CBD (WebMD, 2021) (1).

Interactions

Alsherbiny and Li (2019) (18) indicated that there is a lack of evidence regarding the interaction of CBD with drugs. However, caution should be taken with older adults suffering from liver conditions, kidney disease, or chronic conditions and taking relevant medication.

Potential Side Effects, Toxicity of Cannabidiol and Overdosing Harm

Side effects of CBD

The side effects of CBD are:

  • Low blood pressure
  • Drowsiness
  • Light-headedness
  • Dry mouth
  • Reduced appetite.

Toxicity of CBD

According to Huestis et al. (2019) (19), CBD is not risk-free and is linked to neurotoxicity, developmental toxicity, and embryo-fetal mortality.

Overdosing Harm

The World Health Organization (WHO) and professionals have a consensus that even extremely large doses of CBD can potentially cause diarrhoea and nausea, upset stomach, lethargy, extreme drowsiness, and other disorienting unpleasant side effects but not death.

How to Dose for Other Cannabinoids

Several other cannabinoids are being studied to understand their effect. THC is the majorly found cannabinoid in cannabis while others include Cannabigerol (CBG), Cannabinol (CBN), and Cannabichromene (CBC).

In the United Kingdom (UK), delta 8 THC, delta 9 THC, and CBN are banned whereas there are no official guidelines for the dosage of CBG and CBC. People experiment to identify the effective dose, indicating that start low and start slow is the approach applicable here also.

Moreover, there is no information available in the literature regarding the optimal or effective dose of CBG or CBC. Hence, the best approach is to start low and start slow until concrete evidence is unavailable.

Dosing for a Specific Condition

(Prescription CBD) Dosing for Epilepsy has been stated above, which is an approved condition to be treated with a Cannabidiol based drug and is supported by evidence (Hegde et al., 2012; Kuchenbuch et al., 2020) (20,21). for such a treatment.  However, some cases showed that cannabis use might increase the frequency of seizures. Hence, there is a need to conduct further research to conclude the impact of CBD treatment for epilepsy with stronger evidence.

Moreover, concerning other diseases such as anxiety, insomnia, and arthritis, there is a lack of evidence supporting the claims that CBD use is effective as a treatment option. The problem is that there is too much marketing of CBD products, which has affected the belief of consumers to take this product seriously. Businesses have started selling CBD products claiming with benefits of prevention of disease and cure. These food supplement products are not curative in nature. There is still more research needed to know the benefits and side effects of CBD.

DISCLAIMER: All RUDERALEX® products are sold as food supplements and not intended to diagnose, treat or cure any disease and the contents within this website is for general informational purposes only. It is recommended to check with a physician before starting a new food supplement program. 

Conclusion

In conclusion, it can be said that CBD's role in the field of healthcare as a treatment regimen is still in its initial phase. Only two medications have been approved to be used in the care process. Hence, there is a lack of knowledge regarding the impact of CBD and the dosage to be used for different conditions. It has been suggested that people should use the start low and start slow approach to understand what dosage is effective for them. Several factors affect the dosage such as other health conditions, weight, height, body mass index, and so on, meaning that the dosage varies from one person to another.

The Food Standards Agency (FSA, 2020) (22) has recommended taking no more than 70 mg CBD per day as a food supplement. Future researches will give an insight into the dosage and other uses of CBD.

 

References:

  1. (2021). Cannabidiol (Cbd). https://www.webmd.com/vitamins/ai/ingredientmono-1439/cannabidiol-cbd
  2. US Food and Drug Administration (FDA). (2021). FDA Regulation of Cannabis and Cannabis-Derived Products, Including Cannabidiol (CBD). https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd
  3. Bow, E. W., & Rimoldi, J. M. (2016). The structure–function relationships of classical cannabinoids: CB1/CB2 modulation. Perspectives in medicinal chemistry, 8, PMC-S32171.
  4. Carter A. (2019). A Simple Guide to the Endocannabinoid System. Health Line. https://www.healthline.com/health/endocannabinoid-system
  5. Arzimanoglou, A., Brandl, U., Cross, J. H., GilNagel, A., Lagae, L., Landmark, C. J., ... & other members of The Cannabinoids International Experts Panel. (2020). Epilepsy and cannabidiol: a guide to treatment. Epileptic Disorders, 22(1), 1-14.
  6. Zakharov, S., Tomas, N., & Pelclova, D. (2012). Medication errors—an enduring problem for children and elderly patients. Upsala journal of medical sciences, 117(3), 309-317.
  7. Santos-Longhurst, A. (2019a). How Long Does CBD Stay in Your System?. Healthline. https://www.healthline.com/health/how-long-does-cbd-stay-in-your-system
  8. Santos-Longhurst, A. (2019b). How Much CBD Should I Take the First Time?. Healthline. https://www.healthline.com/health/how-much-cbd-should-i-take-the-first-time
  9. Maghfour, J., Rietcheck, H. R., Rundle, C. W., Runion, T. M., Jafri, Z. A., Dercon, S., ... & Yardley, H. (2020). An Observational Study of the Application of a Topical Cannabinoid Gel on Sensitive Dry Skin. Journal of drugs in dermatology: JDD, 19(12), 1204-1208.
  10. Talley, J. (n.d.). Sublingual CBD – A Complete Guide. Spero CBD. https://www.sperocbd.com/resources/sublingual-cbd-a-complete-guide/
  11. Peters, J., & Chien, J. (2018). Contemporary routes of cannabis consumption: a primer for clinicians. Journal of Osteopathic Medicine, 118(2), 67-70.
  12. Drury, A. (2019). CBD Patches — a Guaranteed Method of Cannabinoid Delivery — Explained. https://weedmaps.com/news/2019/12/what-are-cbd-patches/
  13. Caporuscio, J. (2020). What is the correct dosage of CBD?. Medical News Today. https://www.medicalnewstoday.com/articles/327518
  14. Welty, T. E., Luebke, A., & Gidal, B. E. (2014). Cannabidiol: Promise and Pitfalls: Cannabidiol: Promise and Pitfalls. Epilepsy currents, 14(5), 250-252.
  15. Evans, J. (2020). The Ultimate Guide to CBD: Explore The World of Cannabidiol. Fair Winds Press.
  16. Nickel, J. C. (2018). Medical marijuana for urologic chronic pelvic pain. Canadian Urological Association Journal, 12(6 Suppl 3), S181.
  17. Knopf, A. (2020). FDA on CBD in pregnancy and breastfeeding. The Brown University Child and Adolescent Behavior Letter, 36(4), 9-10.
  18. Alsherbiny, M. A., & Li, C. G. (2019). Medicinal cannabis—potential drug interactions. Medicines, 6(1), 3.
  19. Huestis, M. A., Solimini, R., Pichini, S., Pacifici, R., Carlier, J., & Busardò, F. P. (2019). Cannabidiol adverse effects and toxicity. Current neuropharmacology, 17(10), 974-989.
  20. Hegde, M., Santos-Sanchez, C., Hess, C. P., Kabir, A. A., & Garcia, P. A. (2012). Seizure exacerbation in two patients with focal epilepsy following marijuana cessation. Epilepsy & Behavior, 25(4), 563-566.
  21. Kuchenbuch, M., D'Onofrio, G., Chemaly, N., Barcia, G., Teng, T., & Nabbout, R. (2020). Addon cannabidiol significantly decreases seizures in 3 patients with SYNGAP1 developmental and epileptic encephalopathy.Epilepsia Open, 5(3), 496-500.
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Please note that this article was written by a 3rd-party author who is a specialist on the topic of CBD, hemp and cannabis. Any information or recommendations contained within this article, are independent to the opinion of RUDERALEX® CBD and our employees. We make no claims for any of our products, please read our disclaimer for additional information.