All the Therapeutic System Drugs
Cannabinoids. THC 0.3, 0.9, 1.5, 3, 4.5, 6 mg/drop, CBD 0.6, 0.9, 1.2, 3, 4.5, 6 mg/drop. *This product requires a license for medical cannabis.
BOTTLE. (sublingual drop.): 10gr (330 drops). Dosage should be adjust. individual.
The Israel MOH has outlined in Guidance 106 the 12 indicat. for which med. cannabis is indicated. Accord. to this guidance, the 11 indicat. for this product are:
Chemother-induc. nausea and vomit. (CINV)/ chemother induc. pain.
Metastat. cancer pain.
IBD.
Neuropath. pain.
Spastic. of MS.
Pain in Parkinson's dis.
Cachexia in AIDS.
Tourette's syndr.
Recalcitrant epilep. in adult. (Note: Accord. to Guidance 106, med. cannab. is also indic. for recalcitrant epilep. in ped. pts. but this is not an indicat. for this product)
Palliative care for termin. ill pts.
Post- traum. stress disord.
In general, the use of med. cannabis is indicated in pts. who have adequate. tried and failed convent. ther.
Please refer to Guidance 106 for details.
In addition, for an individ. pt. with a clinical. signific. med. condit. that cannot be adequate. managed by convent. ther. and which is not includ. as one of the 12 approved indicat. (eg autism, fibromyalgia), the physician can appeal to the MOH Committee for Med. Cannabis to ask for approval on an individ. exception. basis.
C/I: Prior, current/ family history (1st degr. relative) of psychos. or schizophr. or schizoaffective disord., a hist. of addict. or substance abuse (include. cannabis use disord.or addict. to alcohol), use in preg.or lact., use in pts. <18 yrs. old, bipol.disord., hypersens. to cannabis, coconut oil, palm kernel oil.
In pts. with hepat. cancer, it is recommend. not to use med. cannab. that contains THC.
See lit.
SNRI. Duloxetine HCl 30 mg, 60 mg. CAPS: 7,14,28 x 30 mg, 60 mg.
intial: 30 mg dly. maint: 60 mg dly.
Ther. response: 2-4 wks aft. tmt. To
discont: Taper by 1/2 dose (30 mg) dly
or on alt. days. See lit.
Major depress. episodes., Generalized
anxiety dis., Neuropath. pain assoc.
with diabet. periph. neuropathy.,
fibromyalg., chron. muscoskeletal pain.
C/I: Concom. use with MAOI,
uncontrolled narrow-angle glaucoma.
SNRI. Duloxetine 30 , 60 mg. CAPS.:30. For diabet. peripher. neuropath. pain: The usual dose is 60 mg ×1/d.
For chron. musculoskel. pain and general. anxiety disord.: For most pts.
60 mg ×1/d. Some pts. require an init. dose of Dulox Teva 30 mg ×1/d for one wk., and then the usual dose of
60 mg ×1/d.
For depression: Most pts. will receive 60 mg ×1/d. Some pts. require an init. dose of Dulox Teva 30 mg ×1/d for one wk., and then the usual dose of 60 mg ×1/d
Elderly – The init. dose of 30 mg ×1/d for two wks., and only then consider incr. the dose to 60 mg ×1/d.
Fibromyalgia: The init. dose of Dulox Teva is 30 mg ×1/d for one wk., and then the usual dose of 60 mg ×1/d. In most cases, the effect of medication ther. with Dulox Teva is noticeab. after 2-4 wks. of tmt.
See lit.
Tmt. of major depressive episodes.
Managem. of neuropath.pain associat. with diabet. peripher. neuropathy.
Tmt. of generaliz. anxiety disord. (GAD).
Manag. of fibromyalgia.
Manag. of chron. muscoskel. pain when other therapies have failed or are
contraindic. This has been establish. in studies in pts. with chron. low back pain (CLBP) and chron. pain due to osteoarthritis.
C/I: Hypersens.
Pts. with hep. dis.
Pts. with severe ren. dis..
Concom. use with MAOI includ. IV methylene blue and the antibiot.linezolid. MAOI should be discount. 14 d. before init.of the tmt. with duloxetine.
Initiat. of MAOI should be start. at least 5 d. after discount. of the tmt. with duloxetine.
Concom. use with thioridazine
GABA Analog. Gabapentin 300 mg, 400 mg. CAPS: 100 x 300 mg, 400 mg. With/out
food with full glass water. Titrate over a
few days to max. dose of 1,800 mg dly
in 3 div. doses. Discont. grad. over min.
of 1 wk. See lit.
Adjunct. tmt. partial seizures with/out
second. generalizat. in adults with epilepsy. Tmt. neuropath. pain in diabet.
neuropathy, post-herpetic neuropathy
(neuralgia).
C/I: Hypersens. See lit.
GABA Analog. Gabapentin 300, 400,. CAPS: 100 x 300 mg, 400 mg. Titrate. to max. 900-1,800 mg dly in 3 div. doses with/without food. To minimize S/E. Day 1: 300 mg at bedt. Day 2: 300 mg 2 xdly; Day 3: 300 mg 3 x dly, not more than 12 hrs apart. Can incr. by 300 mg/ dly in 3 div. doses to max. 1800 mg/ day. To discont.,decr. orsubstit: Grad. over min. 1 wk. Elderly: Adjust as reqd. See lit.
As adjunct.ther. in the tmt. of part. seizures
with and without second. generaliz. in adults
with epilepsy. – Tmt. of neuropath. pain in
diab. neuropat. orpostherpeticneuropat.(neuralgia).
C/I: Hypersens.
Anticonvulsant. Pregabalin 25, 50, 75, 100, 150, 200, 225, 300 mg. CAPS: 14, 56 x 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, 300 mg.
The dose range is 150-600 mg/d in 2-3 divid. doses.
Neuropathic pain 150 mg/d in 2-3 divid. doses. Based on individ. pt. response and tolerab. the dosage dose may be incr. to 300 mg/d after an interv. of 3-7 d., and if needed, to a max. dose of 600 mg/d after an addit. 7-day interv.
Fibromyalgia: 300-450 mg/d in 2 divid. doses. Some pts. may derive addit. benefit at 600 mg/d. Dosing should begin at 75 mg×2/d (150 mg/d) and may be incr. to 150 mg×2/d (300 mg/d) within 1 wk. based on efficacy & tolerabil.
Generalis. anxiety disord. (GAD): The dose range is 150-600 mg/d given as two/three divid. doses. The need for tmt. should be reassessed regularly.
Pregabalin tmt. can be started with a dose of 150 mg/d. Based on individ. pt. response and tolerab., the dose may be incr. to 300 mg/d after 1 wk. Follow. an addit. week the dose may be incr. to 450 mg/d. The max. dose of 600 mg/d may be achieved after an addit. wk.
Discont. of pregabalin: In accordance with current clinical practice, if pregabalin has to be discont. it is recomm. this should be done gradually over a minimum of 1 wk. independ. of the indication.
Tmt. of peripher. & central neuropath. pain in adult.
Managem. of fibromyalgia.
Tmt. of (GAD) in adult.
C/I: Hypersens.
