THC: CBD spray (Sativex)

What is Sativex and what does it do?

Sativex is a cannabis-based medicine that you spray into your mouth. It is used to treat muscle stiffness and spasms (called 'spasticity') in people with multiple sclerosis (MS) when other treatments haven't worked.

You have been chosen to try Sativex for four weeks. After this trial period, the Rehabilitation team will review your progress and decide whether you should continue using it.

How do I take Sativex?

To find the right dose for you, you will start with a low dose and gradually increase it. This helps to get the best benefit with the least side effects.

Start with one spray a day. Increase by one spray each day until you reach a maximum of 12 sprays a day, or until your muscle stiffness improves or you can't tolerate the side effects.

Shake the spray container before each use. Leave at least a 15-minute gap between sprays. When you start taking a morning dose, take it any time between waking up and midday. Take the evening dose any time between 16:00 (4pm) and bedtime.

If you experience side effects, reduce your dose by one or two sprays per day until the side effects improve. Continue recording your doses and symptoms in the diary.

You should also regularly change the part of your mouth you spray to avoid soreness in your mouth.

Use the table below to guide your dosing schedule and to record your spasticity, spasms, and pain scores (each from 0 to 10, with 0 being the best and 10 being the worst) along with any notes each day. This will help the Rehabilitation team assess your progress.

Please continue tracking in your own diary after day 28.

Are there any side effects?

As with any medication, Sativex can cause unwanted side effects. These vary from person to person and are most likely to occur when you start treatment. Side effects often decrease as you become more used to Sativex.

Most common side effects:

• Feeling dizzy or tired
• Memory or concentration problems
• Feeling sleepy
• Feeling sick
• Constipation or diarrhoea
• A dry mouth

Stop taking Sativex and speak to a healthcare professional or go to a hospital straight if you notice any of the serious side effects:

• Seeing or hearing things that are not there (hallucinations)
• Believing ideas that are not true
• Feeling that other people are against you
• Thoughts of suicide
• Feeling depressed or confused
• Feeling over-excited or losing touch with reality

How to store Sativex?

• Store unopened Sativex bottles upright in a fridge.
• Once opened, Sativex bottles can be stored for up to 42 days below 25°C (outside the fridge).
• Do not use Sativex after it has been open for 42 days.
• Return any empty or unfinished bottles to the pharmacy for safe disposal.

Alcohol and Sativex

Avoid drinking alcohol while using Sativex. Alcohol may increase the effects you feel from Sativex, such as dizziness and drowsiness.

Driving and Sativex

• Sativex may cause you to feel sleepy or dizzy, which can impair your ability to drive.
• Do not drive or use machinery until you are on a stable dose and are used to taking it.
• If you feel sleepy or dizzy from Sativex, do not drive or operate machinery.

Foreign travel with Sativex

• Sativex is a controlled drug and its legal status varies between countries
• Before travelling, check if it is legal to take Sativex to your destination and any countries you are passing through.
• Driving with Sativex might be illegal in some countries.
• Check the latest government information before travelling (opens in a new tab).

Pregnancy and breastfeeding

• If you are pregnant, think you may be pregnant, or are planning to have a baby, ask the Rehabilitation team for advice before using Sativex.
• Do not use Sativex during pregnancy or breastfeeding.

Contraception

Sativex may reduce the effectiveness of hormonal contraception, like the pill or contraceptive implants. You should use an additional type of contraception, such as a copper intrauterine device (IUD), progestogen-only injection, or levonorgestrel-releasing intrauterine system (IUS), while taking Sativex and for three months after stopping. Both men and women should use barrier methods, like condoms or diaphragms, during treatment and for three months after.

Full details of Sativex Oromucosal Spray summary of product characteristics, can be found on the UK Medicines website (opens in a new tab).

How will I receive my Sativex prescription?

You can collect your first 28 days prescription of Sativex from the outpatient pharmacy at CUH. At week 4, the Rehabilitation team will assess whether Sativex is helping you. If you continue treatment with Sativex, you can collect a supply from the outpatient pharmacy every three months.

Contacts/Further information

Neurorehabilitation Service

Dr Fahim Anwar and Dr Cynthia Udensi’s secretary: 01223 217386
Dr Stephen Kirker’s secretary: 01223 217870
Email the Neuro Rehab Team