The titration of Epidyolex should be slowly as it should be in all anti-epileptic drugs. Usually you should start with a dose of 5 mg/kg/day divided in two doses. You can go up to 10mg/ kg/day after one week and after that you can increase the dose up to a maximum of 20mg/ kg/day, if the response in terms of seizure frequency is not good enough on 10mg and the drug is well tolerated from possible side e ects.
Reaching a therapeutic dose is important. A dose of 10mg/kg a day was the lowest e ective dose in the Epidyolex studies and clinical experience with cannabidiol shows the same. That means when you stay on the initial dose of 5mg/kg a day, you might observe a short lasting improvement of seizures but this e ect will not last too long so it’s highly recommended to go to the recommended therapeutic dose of the drug. It is a common mistake in anti-epileptic therapy to prescribe too low doses of anti-epileptics and then come to the conclusion that the drug does not help.
An elevation of transaminase levels can occur on the treatment of Epidyolex especially if it is in combination with Valproate. The cause of this is unknown and it’s often of a transient nature. Therefore it is recommended to monitor the transaminase and the bilirubin levels one, three and six months after starting Epidyolex.