Epidiolex and CBD Dosages: Your GoodRx Guide

Cannabidiol, or CBD, is an active ingredient found in the cannabis plant. It’s available as a prescription medication called Epidiolex that was FDA approved in 2018. CBD is also sold as an over-the-counter (OTC) supplement in many different forms.

But what’s the right amount of CBD to take? Below, we’ll review the recommended Epidiolex dosages. We’ll also review some general recommendations for CBD dosages when you’re taking OTC products.

What’s the typical Epidiolex dosage?

Epidiolex is approved for adults and children ages 1 year and older. It’s prescribed for seizures caused by certain health conditions. These conditions are more common in children than adults, so Epidiolex is usually taken by children. This is why it comes as a liquid instead of a pill.

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Storing and administering Epidiolex 

Epidiolex liquid contains 100 mg of CBD per 1 mL. It’s strawberry flavored and can be stored at room temperature. Once a bottle is opened, it’s good for 12 weeks. If any liquid remains after 12 weeks, you should discard it and open a new bottle.

Epidiolex comes with two different sizes of dosing syringes (1 mL and 5 mL). Be sure to review which one you should use when you pick it up from the pharmacy. Don’t switch between the two syringe sizes, and don’t use a household spoon to measure the dose. This could lead to measuring an incorrect dose. Don’t hesitate to call your provider or pharmacist for help if you’re unsure about the dosing once you’re at home.

You can take Epidiolex with or without food. But food can affect how Epidiolex is absorbed. So it’s best to be consistent with when and how you take it. If you decide to take it with food, you should do so every day.

Seizures caused by Lennox-Gastaut or Dravet syndromes

Lennox-Gastaut syndrome (LGS) and Dravet syndrome (DS) are two types of epilepsy that are common in infants and young children. They both cause seizures and may lead to developmental delays as well. And they’re difficult to treat with traditional medications.

Epidiolex is approved to treat seizures caused by LGS and DS. The dose is calculated based on body weight. You or your child will start with an Epidiolex dosage of 2.5 mg per kg of body weight twice daily. After one week, your provider may raise the dosage to 5 mg per kg of body weight twice daily.

If seizures persist, your provider may continue to raise the dosage by 2.5 mg per dose up to a maximum of 10 mg per kg of body weight twice a day. There should be at least one day in between each dose increase.

Seizures caused by tuberous sclerosis complex

Tuberous sclerosis complex (TSC) is a rare condition that causes tumors to grow throughout the body. They aren’t cancerous, but when tumors grow in the brain it can cause seizures.

The Epidiolex dosage for TSC starts with 2.5 mg per kg of body weight twice daily. From there, the dosage will gradually increase up to the recommended dose 12.5 mg per kg of body weight twice daily. Your provider will decide how quickly to increase your dose — there isn’t a set time period between each change. Doses lower than 12.5 mg per kg of body weight haven’t been studied for TSC.  

Are there any dosage adjustments for medical conditions?

Epidiolex is removed from the body by the liver. So if you have liver problems, It can be harder for your body to remove it. This means the amount of Epidiolex in your blood may be higher than usual, which can raise your risk of side effects.

If you have moderate to severe liver problems, a lower Epidiolex dosage is recommended. For moderate liver problems, you’ll start with 1.25 mg per kg of body weight twice daily and then increase the dosage to:

• 2.5 mg to 5 mg per kg of body weight twice daily for LGS and DS

• 6.25 mg per kg of body weight twice daily for TSC 

For severe liver problems, you’ll start with 0.5 mg per kg of body weight twice daily and increase the dosage to:

• 1 mg to 2 mg per kg of body weight twice daily for LGS and DS

• 2.5 mg per kg of body weight twice daily for TSC.

What’s the typical CBD dosage if you’re taking an OTC product?

CBD products sold in pharmacies or health-food stores aren’t regulated by the FDA. This means there aren’t any health conditions that CBD being sold OTC is approved to treat. So there aren’t set dosages to take, either.

There’s some evidence that taking CBD by mouth may help with anxiety, insomnia, and pain. It’s also been studied as a possible treatment for substance use disorder and depression. But more studies are needed to better understand how CBD works and what conditions it’s likely to help with. Clinical studies have used CBD dosages ranging from 16 mg to 1000 mg daily. This wide range makes it hard to know exactly where to start when it comes to recommending a CBD dosage.

In general, experts recommend starting with a low dose of CBD, such as 5 mg by mouth twice a day. From there, you can slowly raise your dose over time to find what works best for your symptoms. This helps your body adjust to the medication and lowers the chance for negative side effects. In general, oral CBD doses of up to 40 mg daily may be more helpful for pain, while higher doses of 300 mg to 600 mg daily may be more helpful for anxiety.

Keep in mind that these are general recommendations, not FDA-approved dosages. If you’re considering taking a CBD product, it’s best to discuss it with your healthcare provider first. They can help make sure it’s safe for you and help you find the best dosage for your needs.

Good to know: Since CBD products aren’t well regulated, many of the products sold OTC may contain other ingredients not listed on the package. Or they may contain a different amount of CBD than what’s listed. So it’s best to take extra steps to make sure you’re buying a high quality CBD product.

What happens if you miss a dose of Epidiolex?

If you miss a dose of Epidiolex, take it as soon as you remember. If it’s almost time for your next dose, skip the missed dose and take the next dose as scheduled. Don’t take two doses at once to make up for a missed dose.

Missing multiple doses of Epidiolex raises the risk of seizures, so it’s best to take extra steps to help you remember to take it or give it to your child. Medication reminder apps and calendar alerts are helpful options. It may also be hopeful to keep the medication bottle somewhere you’ll see it often, like on the kitchen counter. Just be sure to keep it out of the reach of children.

What should you do if you take too much Epidiolex?

If you take more Epidiolex than prescribed, it’s unlikely to be dangerous to your health. But side effects such as drowsiness, diarrhea, and upset stomach are more likely. High doses of Epidiolex can also cause an increase in your liver enzymes, which is an early sign of possible liver damage.

Let your healthcare provider know if you or your child takes more Epidiolex or CBD than recommended. They can recommend the best course of action. You can also contact Poison Control at 1-800-222-1222.

CBD products sold OTC are likely to have a similar effect to Epidiolex if you take more than recommended. But since OTC products aren’t as regulated, there’s a higher chance that another ingredient in your CBD product could be harmful if you take too much of it. So it’s a good idea to contact your provider or Poison Control if you take more of any CBD product than recommended. And seek emergency care if you have any symptoms that seem concerning.

Keep in mind: It’s best to store Epidiolex and CBD products out of the reach of children — even if the medication is for them. Children can often mistake medication for candy and take more than they should. Prevention is the best way to prevent an overdose from happening.

How to save on Epidiolex

 There are ways to save on Epidiolex, which is only available as a brand-name medication. GoodRx can help you navigate between patient assistance programs and copay savings cards to save money on your prescription.

• Save with a copay savings card. If you have commercial insurance, you may be eligible to pay as little as $0 for Epidiolex using a savings card from the manufacturer.

• Save with specialty programs. You may be able to receive 60 days of Epidiolex at no cost while you’re waiting for insurance approval. And you can receive a 30-day supply of Epidiolex at no cost if you’re sent home from the hospital before you can get a prescription filled to use at home. Your healthcare provider can help you enroll in these programs if you’re eligible.

• Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Epidiolex’s patient assistance program, which offers the medication at no cost.

Good to know: Epidiolex is a limited distribution drug, which means not every pharmacy carries it. You’ll likely need to have your prescription filled at a specialty pharmacy, and it may take longer than usual to set up and receive the medication. The good news is that specialty pharmacies will often go the extra mile to help you get insurance approval and/or take advantage of discounts and programs to help you afford your medication.

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Written by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

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