Sativex

Cannabidiol and delta-9-tetrahydro-cannabinol

• Brand(s): Sativex
• Dosage Form/Strength: 25 mg/27 mg per mL buccal spray

For the treatment of neuropathic pain related to multiple sclerosis in patients who have:

1. Ineffective response or intolerable side effects / contraindications to adequate trials* of a tricyclic antidepressant and gabapentin and pregabalin; and
2. Ineffective response or intolerable side effects / contraindications to adequate trials* of Cesamet (nabilone) and Marinol (delta-9-tetrahydrocannabinol); and
3. No contraindications to Sativex therapy.

*Adequate trial is defined as 2 months unless intolerable side effect(s) occur.

Duration of Approval: 1 Year

Note: Side effects and contraindications must be described in detail. Side effects should be deemed serious by the physician such that no further therapy with the agent would be warranted.

Renewal will be considered for patients responding to Sativex therapy as demonstrated by decreased pain and other pain-related symptoms; no initiation of new analgesics; and no increase in doses of any analgesics.

Duration of Approval: Renewal is lifetime.

Sativex is also reimbursed for the treatment of refractory pain in palliative cancer patients according to specified criteria.

Duration of Approval: 6 Months

EAP Drug Request Form:

Standard Form for EAP Drug Requests