Medicinal cannabis information sheet

Contact details

Pharmacy, The Children’s Hospital at Westmead

Telephone: (02) 7825 2711

Introduction

Medicinal cannabis can be used to manage seizures in children with Dravet syndrome, Lennox-Gastaut syndrome and Tuberose Sclerosis complex. It can be prescribed with other anti-epileptics. 

What is medicinal cannabis?

Most medicinal cannabis products contain chemicals known as cannabinoids. Two of these are Cannabadiol (CBD) and Tetra-hydrocannabinol (THC). CBD and THC are natural compounds found in the cannabis sativa plant. Marijuana is the name given to the dried leaves, flowers, stems and seeds of the cannabis sativa plant. 

Epidyolex 

  • Epidyolex is an oral cannabis medication containing cannabidiol that has the psychoactive component (THC) removed. It is approved by the TGA and can be accessed with a prescription for use in children.  

  • Epidyolex has been approved on the PBS for use in Dravet’s syndrome. Not all cannabis products labelled 'medicinal cannabis' are approved by the regulatory body, the Australian Government Therapeutic Goods Association (TGA). 

Tetra-hydrocannabinol (THC) 

  • THC is the chemical that affects a person’s mental state (the psychoactive component). CBD does not have the same effect. 

  • Epidyolex is an oral cannabis medication containing cannabidiol that has the psychoactive component (THC) removed. It is approved by the TGA and can be accessed with a prescription for use in children. Epidyolex has been approved on the PBS for use in Dravet’s syndrome.  

Cannabidiol (CBD) 

  • The CBD oil products that are approved by the TGA are very pure forms, which means there is very little or no THC present.   

  • Although CBD oil is mostly made up of CBD, a small amount of THC may be present. The amount of THC varies depending on the type of CBD oil. 

Medication instructions

How to give Medicinal Cannabis

Cannabidiol is best taken at approximately the same time of day and comes in a suspension. The suspension needs to be shaken well before use and can be taken either with/without food. Measure dose accurately with syringe or measuring spoon. 

Cannabis products that can be accessed without prescription may be of lower purity and higher in THC than CBD. It is not possible to predict short or long term effects if the product ingredients are unknown.    

There are drugs including other anti-epileptics that interact with cannabidiol. It is important that children taking medicinal cannabis are regularly monitored by their usual treating paediatric neurologist to ensure that levels of other medicines are appropriately managed.  

There may be significant interactions between medicinal cannabis and other anticonvulsants such as:  

  • Sodium valproate 

  • Clobazam 

  • Lamotrigine 

  • Stiripentol 

  • Phenytoin 

This is also important if you are giving your child herbal or complementary medicines. The doctor can check to make sure they are compatible. 

Monitoring and medication levels 

Regular monitoring of liver function and drug interactions by the child's treating doctor is important. 

Pregnancy and contraception 

If a pregnancy is planned, a discussion with your neurologist is recommended. For further information, refer to the Contraception and Pregnancy section. 

What to do if your child vomits

  • If your child vomits within 30 minutes after having their dose, then repeat the dose.
  • If it is longer than 30 minutes since having the dose you do not need to repeat the dose, but if vomiting or diarrhoea continues, seek medical help.

What to do if your child misses a dose

  • If a dose is missed, it should be taken as soon as it is remembered.
  • The next due dose should be taken at the usual time.
  • However, if the missed dose is remembered in close proximity to the next due dose (i.e. within 3 to 4 hours of the next dose), please seek medical advice.
  • If unsure about what to do, the treating GP, epilepsy nurse, paediatrician or neurologist should be contacted.

Medication storage and safety

Storage

Medicinal cannabis must be stored securely and may need refrigeration. Always follow the instructions of your doctor and pharmacist. 

Side effects

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. 

Possible side effects include: 

  • Sleepiness / drowsiness 

  • Irritability, changes in mood and behaviour 

  • Fatigue / lack of energy 

  • Changes in appetite 

  • Diarrhoea and/or vomiting  

  • Fever 

  • Upper respiratory tract infection  

  • Increased seizures 

  • Elevated liver enzymes 

  • CBD oil may also cause side effects if it interacts with other medicines (see interactions tab). 

For information about reproductive health and medicinal cannabis, please ask your doctor and see more information the reproductive health section.

The information provided in this resource is limited and does not replace the need for a medical consultation. It is very important you speak to your doctor about all aspects of your medication including side effects when medication is first prescribed. Report any concerns to your doctor promptly. 

Medication scripts

Please ask your child’s doctor at a follow up appointment for another medication script if required.

If this is a regular medicine for your child, the GP should be your first point of call for repeat prescriptions. 
 

Overdose information

In the case of an overdose or poisoning, call the NSW Poisons Information Centre on 13 11 26 (24 hour service).