European Medical Journal (Jun 2020)
National Institute for Health and Care Excellence (NICE) Guidelines on Cannabis-Based Medicinal Products: Clinical Practice Implications for Epilepsy Management
Abstract
The UK’s National Institute for Health and Care Excellence (NICE) has produced new evidence-based guidance on the prescription of cannabis-based medicinal products (CBMP) to treat epilepsy, chronic pain, spasticity, and intractable nausea and vomiting. For epilepsy, cannabidiol (CBD) (Epidyolex®, GW Pharmaceuticals, Cambridge, UK) is recommended in conjunction with clobazam for treating seizures associated with Lennox–Gastaut syndrome and Dravet syndrome in patients aged ≥2 years. Other CBMP covered by the NICE guidelines include the licensed product Δ-9-tetrahydrocannibinol (THC), combined with CBD (Sativex®, GW Pharmaceuticals, Cambridge, UK), nabilone, and synthetic compounds that are identical in structure to naturally occurring cannabinoids such as dronabinol. Understanding the clinical practice implications of these new NICE guidelines will enable clinicians to ensure patients that are suitable for treatment benefit from these important new treatment options, against a backdrop of increasingly avid patient and public interest. Optimal dosing, monitoring, and management of patient expectations will prove key to successfully implementing CBMP into the challenging clinical setting. It is also vital that doctors continue to draw a firm distinction between unregulated CBD products and licensed medications which have been rigorously tested in clinical trials. Unregulated products are associated with issues such as variability in active ingredient concentrations, labelling inconsistencies, impurities and contaminants compromising therapeutic efficacy, and risk of potentially exposing users to harm. This review summarises the new NICE guidelines on CBMP for severe treatment-resistant epilepsy, considers how guidelines will impact the management of epilepsy in clinical practice, and reiterates the key risks posed by unregulated cannabis-based products.
