THC + CBD oromucosal spray

Cannabis extract

Brand names: Sativex (nabiximols)

Adult dose

Dose: Titrate from 1 spray daily, increase by 1 spray/day to max 12 sprays/day

Route: Oromucosal

Frequency: Up to QDS

Clinical pearls

NICE NG144 cannabis-based medicinal products: severe MS spasticity unresponsive to other antispasmodics
ABN MS spasticity / NICE TA review
Specialist neurology; trial-of-treatment with documented benefit at 4 weeks

Contraindications

Personal/family history of psychosis
Severe cardiovascular disease
Pregnancy/breastfeeding
Children
Hypersensitivity

Side effects

Dizziness
Fatigue
Mood change
Hallucinations
Tachycardia
Falls
Dependence (theoretical)

Interactions

CNS depressants
Strong CYP3A4 inhibitors/inducers

Monitoring

Spasticity score
Mental state
Cardiovascular tolerance
Driving (DVLA)

Reference: BNF; NICE NG144; ABN MS spasticity; SmPC; https://bnf.nice.org.uk/drugs/cannabis-extract/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Pathways