Dosage titration

Titration is the stepwise adjustment of medication dose to balance therapeutic efficacy against side-effect burden. In cannabinoid therapy the established mantra is **"start low, go slow"** — a deliberately conservative protocol that reflects the substantial individual variation in endocannabinoid-system tone and the dose-dependent nature of most cannabinoid side effects.

**Typical starting doses:** - THC: 2.5 mg per dose, often once-daily evening (sedating regimens) or twice-daily lower (daytime tolerability). - CBD: 10–25 mg per dose, often twice or three times daily. - Balanced THC:CBD oils: doses are quoted as combined; start at the equivalent of ~2.5 mg THC.

**Increment cadence** — typically weekly or bi-weekly review, with dose increases of one step at a time. Faster titration tends to produce side effects without commensurate benefit.

**Holding criterion** — hold at the lowest dose delivering clinical benefit, not the highest tolerated dose. The goal is symptom control with the least cannabinoid load, both for tolerability and for sustainability across the 6-month authorisation.

**Stop / reassess criteria** — if no measurable benefit is achieved after a fair trial (typically 4–8 weeks at stable dosing), the doctor will pivot rather than persist. Persistent dose-creep without endpoint improvement is a sign the indication is not responding and the regimen should change.

**Tolerance management** — particularly for THC-containing regimens, periodic dose-holidays (24–48 hours every 2 weeks) help preserve receptor sensitivity and limit dose-creep over months.