Dosage Strategies: The Science Behind 'Start Low, Go Slow"

The "start low, go slow" dosing strategy is well-known in prescribing and dispensing circles, but why is it such fundamental advice to patients starting on medicinal cannabis?

Pharmacokinetic and Pharmacodynamic Variability

Individual differences in cannabinoid receptor expression (CB1 and CB2), variations in first-pass metabolism in the liver, and the influence of genetic polymorphisms (e.g., CYP2C9 and CYP3A4) emphasise the need for personalised dosage considerations.

Patient Response and Tolerance

There is considerable variability in individual patient response and tolerance, which can be influenced by many factors such as age, weight, overall health, and prior cannabis experience.

Minimising Side Effects

By initiating treatment with a conservative dose, practitioners can help minimise potential side effects, such as dizziness, fatigue, or changes in cognitive function.

Individualised Therapeutic Goals

Different medical conditions may require varying doses of cannabinoids to achieve optimal therapeutic effects. By initiating treatment cautiously, providers can observe how patients respond to lower doses and gradually titrate upward.

Building Patient Confidence

Starting with a low dose allows for a gradual patient acclimatisation so they are more likely to adhere to their treatment plans and feel comfortable discussing their experiences with their provider.

By adhering to “start low, go slow” practitioners can help ensure a more personalised and safer introduction to medicinal cannabis, optimising the therapeutic benefits while minimising potential risks.