Patients gradually titrate their dose (number of sprays per day) during the first two weeks of treatment.1
On day 1 patients take one spray of Sativex in the evening (between 4pm and bedtime). They then gradually increase their dose following the pattern given in the table below until they reach a dose that provides optimum symptom relief.1
|Dose titration schedule for Sativex1|
|Day||Number of sprays in the morning (between waking and midday)||Number of sprays in the evening (between 4pm and bedtime)||(Total number of sprays per day)|
Once they have titrated their dose to achieve optimum symptom relief, patients can adjust their dose according to how they are feeling on a day-to-day basis, and over time as their disease progresses.
Maximum recommended dose
Patients may increase their dose up to a maximum of 12 sprays per day if needed.1 This information is also included in the Patient Information Leaflet and the patient booklet.
In routine clinical practice, the median number of daily sprays is 4.2 In clinical trials, the median number of daily sprays used by MS patients was 8.1
Patients should leave at least 15 minutes between two successive sprays.
The dose diary
Patients taking Sativex are strongly advised to keep a dose diary record. This record of their dosing regimen should include notes about the benefits they gain from each daily dose they try, and any unwanted effects they experience as they increase their dose.
Review by a specialist
The patient’s response to Sativex is reviewed by the specialist physician after four weeks of treatment. If a clinically significant improvement in spasticity-related symptoms is not seen during this initial trial of therapy, treatment should be stopped.The value of long-term treatment should also be re-evaluated periodically.1