AUSTRALIADosing Diary for Medical Cannabis Use

This dosing diary is intended for patients who have been prescribed a product from the LGP Classic range of medical cannabis in Australia. This may be useful to share atfollow-up appointments with your doctor. Information provided in this document does not replace professional advice from your doctor. Please also read the Consumer Medicine Information leaflet which is supplied inside the box of all Little Green Pharma products.

02 DOSING GUIDE

04 YOUR DAILY DOSING DIARY GENERAL OVERVIEW

05 YOUR DAILY DOSING DIARY

19 GENERAL NOTES

20 RESOURCES

TABLE OF CONTENTS

2 3

Dosing Guide‘start low, go slow’

Dosing remains highly individualised. The TGA recommends a start low and go slow approach in line with international guidelines. The aim is to reach a dose where benefits are maximised and adverse effects minimised. The rate and speed of dose adjustment will depend on the individual response. Please fill in the dosing template below with input from your treating practitioner.

The TGA recommends a ‘start low, go slow’1 approach to dosing, in line with international guidelines.2-4 Please fill in the dosing template below with input from your practitioner.

The following section in this booklet is a Dosing Diary which can be used to keep track of your symptoms and mood before and after using medical cannabis. This can be useful to share in future doctor appointments.

1. Therapeutics Goods Administration, ‘Guidance for the use of medicinal cannabis in Australia, Overview’, Australian Government, Department of Health, Therapeutic Goods Administration, 2017, https:// www.tga.gov.au/sites/default/files/guidance-use-medicinal-cannabisaustralia overview.pdf (accessed April 2020).

2. Abramovici, H., ‘Information for Health Care Professionals: Cannabis (marihuana, marijuana) and the cannabinoids’, Health Canada, 2013, https://www. canada.ca/en/health-canada/services/drugs-medication/cannabis/information-medical-practitioners/information-health-care-professionals-cannabis-cannabinoids.html (accessed 17 January 2019).

3. Landschaft, Y., ‘The Green Book: The Official Guide to Clinical Care in Medical Cannabis’, Israeli Ministry of Health, 2017, https://www.xn--4dbcyzi5a. com/en/2018/01/medical-cannabis-official-israeli-clinical-guide/ (accessed 28 January 2019).

4. Nederlandse Associatie voor legale Cannabis en haar Stoffen als Medicatie, ‘The Dutch Medicinal Cannabis Program: Indications for medicinal cannabis use’, The Office of Medical Cannabis, 2008, http://www.ncsm.nl/english/information-for-patients/when-to-use-it-indications (accessed 12 November 2018).

REFERENCES

Dosing Template (start low, go slow)114 Day TemplateThis does not replace a patient

treatment monitoring plan from a medical practitioner

DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7

Morning mL mL mL mL mL mL mL

Evening mL mL mL mL mL mL mL

DAY 8 DAY 9 DAY 10 DAY 11 DAY 12 DAY 13 DAY 14

Morning mL mL mL mL mL mL mL

Evening mL mL mL mL mL mL mL

5

20: 5

THC Dominant

10: 10

THC/CBD Balance

1 :20

CBD Dominant

CBD

CBD 50 or 1:100

Product

Additional comments: Unwanted effects? Unexpected benefits?

Your Daily Dosing DiaryPatient Name: Date: / /

Dose consumed

mL

mL

mL

mL

AM

AM

PM

PM

Time of use Comments (e.g. effects on symptoms)

The scale is from 1 to 10 with 10 indicating the best health you can imagine and 1 indicating the worst health you can imagine.

Thinking of your overall health, please indicate below how you are feeling today?

1 2 3 4 5 6 7 8 9 10

4

Your Daily Dosing Diary General Overview

Date: / /

Patient Name:

Condition(s):

Indicate your symptom(s) score by adding number 1 (mild) to 10 (severe) for when you start your daily dosing diary and again after 14 days.

DAY 1 DAY 14

SYMPTOM 1:

SYMPTOM 2:

SYMPTOM 3:

SYMPTOM 4:

6 7

20: 5

THC Dominant

10: 10

THC/CBD Balance

1 :20

CBD Dominant

CBD

CBD 50 or 1:100

Product

Additional comments: Unwanted effects? Unexpected benefits?

Your Daily Dosing DiaryPatient Name: Date: / /

Dose consumed

mL

mL

mL

mL

AM

AM

PM

PM

Time of use Comments (e.g. effects on symptoms)

The scale is from 1 to 10 with 10 indicating the best health you can imagine and 1 indicating the worst health you can imagine.

Thinking of your overall health, please indicate below how you are feeling today?

1 2 3 4 5 6 7 8 9 10

20: 5

THC Dominant

10: 10

THC/CBD Balance

1 :20

CBD Dominant

CBD

CBD 50 or 1:100

Product

Additional comments: Unwanted effects? Unexpected benefits?

Your Daily Dosing DiaryPatient Name: Date: / /

Dose consumed

mL

mL

mL

mL

AM

AM

PM

PM

Time of use Comments (e.g. effects on symptoms)

The scale is from 1 to 10 with 10 indicating the best health you can imagine and 1 indicating the worst health you can imagine.

Thinking of your overall health, please indicate below how you are feeling today?

1 2 3 4 5 6 7 8 9 10

8 9

20: 5

THC Dominant

10: 10

THC/CBD Balance

1 :20

CBD Dominant

CBD

CBD 50 or 1:100

Product

Additional comments: Unwanted effects? Unexpected benefits?

Your Daily Dosing DiaryPatient Name: Date: / /

Dose consumed

mL

mL

mL

mL

AM

AM

PM

PM

Time of use Comments (e.g. effects on symptoms)

The scale is from 1 to 10 with 10 indicating the best health you can imagine and 1 indicating the worst health you can imagine.

Thinking of your overall health, please indicate below how you are feeling today?

1 2 3 4 5 6 7 8 9 10

20: 5

THC Dominant

10: 10

THC/CBD Balance

1 :20

CBD Dominant

CBD

CBD 50 or 1:100

Product

Additional comments: Unwanted effects? Unexpected benefits?

Your Daily Dosing DiaryPatient Name: Date: / /

Dose consumed

mL

mL

mL

mL

AM

AM

PM

PM

Time of use Comments (e.g. effects on symptoms)

The scale is from 1 to 10 with 10 indicating the best health you can imagine and 1 indicating the worst health you can imagine.

Thinking of your overall health, please indicate below how you are feeling today?

1 2 3 4 5 6 7 8 9 10

10 11

20: 5

THC Dominant

10: 10

THC/CBD Balance

1 :20

CBD Dominant

CBD

CBD 50 or 1:100

Product

Additional comments: Unwanted effects? Unexpected benefits?

Your Daily Dosing DiaryPatient Name: Date: / /

Dose consumed

mL

mL

mL

mL

AM

AM

PM

PM

Time of use Comments (e.g. effects on symptoms)

The scale is from 1 to 10 with 10 indicating the best health you can imagine and 1 indicating the worst health you can imagine.

Thinking of your overall health, please indicate below how you are feeling today?

1 2 3 4 5 6 7 8 9 10

20: 5

THC Dominant

10: 10

THC/CBD Balance

1 :20

CBD Dominant

CBD

CBD 50 or 1:100

Product

Additional comments: Unwanted effects? Unexpected benefits?

Your Daily Dosing DiaryPatient Name: Date: / /

Dose consumed

mL

mL

mL

mL

AM

AM

PM

PM

Time of use Comments (e.g. effects on symptoms)

The scale is from 1 to 10 with 10 indicating the best health you can imagine and 1 indicating the worst health you can imagine.

Thinking of your overall health, please indicate below how you are feeling today?

1 2 3 4 5 6 7 8 9 10

12 13

20: 5

THC Dominant

10: 10

THC/CBD Balance

1 :20

CBD Dominant

CBD

CBD 50 or 1:100

Product

Additional comments: Unwanted effects? Unexpected benefits?

Your Daily Dosing DiaryPatient Name: Date: / /

Dose consumed

mL

mL

mL

mL

AM

AM

PM

PM

Time of use Comments (e.g. effects on symptoms)

The scale is from 1 to 10 with 10 indicating the best health you can imagine and 1 indicating the worst health you can imagine.

Thinking of your overall health, please indicate below how you are feeling today?

1 2 3 4 5 6 7 8 9 10

20: 5

THC Dominant

10: 10

THC/CBD Balance

1 :20

CBD Dominant

CBD

CBD 50 or 1:100

Product

Additional comments: Unwanted effects? Unexpected benefits?

Your Daily Dosing DiaryPatient Name: Date: / /

Dose consumed

mL

mL

mL

mL

AM

AM

PM

PM

Time of use Comments (e.g. effects on symptoms)

The scale is from 1 to 10 with 10 indicating the best health you can imagine and 1 indicating the worst health you can imagine.

Thinking of your overall health, please indicate below how you are feeling today?

1 2 3 4 5 6 7 8 9 10

14 15

20: 5

THC Dominant

10: 10

THC/CBD Balance

1 :20

CBD Dominant

CBD

CBD 50 or 1:100

Product

Additional comments: Unwanted effects? Unexpected benefits?

Your Daily Dosing DiaryPatient Name: Date: / /

Dose consumed

mL

mL

mL

mL

AM

AM

PM

PM

Time of use Comments (e.g. effects on symptoms)

The scale is from 1 to 10 with 10 indicating the best health you can imagine and 1 indicating the worst health you can imagine.

Thinking of your overall health, please indicate below how you are feeling today?

1 2 3 4 5 6 7 8 9 10

20: 5

THC Dominant

10: 10

THC/CBD Balance

1 :20

CBD Dominant

CBD

CBD 50 or 1:100

Product

Additional comments: Unwanted effects? Unexpected benefits?

Your Daily Dosing DiaryPatient Name: Date: / /

Dose consumed

mL

mL

mL

mL

AM

AM

PM

PM

Time of use Comments (e.g. effects on symptoms)

The scale is from 1 to 10 with 10 indicating the best health you can imagine and 1 indicating the worst health you can imagine.

Thinking of your overall health, please indicate below how you are feeling today?

1 2 3 4 5 6 7 8 9 10

16 17

20: 5

THC Dominant

10: 10

THC/CBD Balance

1 :20

CBD Dominant

CBD

CBD 50 or 1:100

Product

Additional comments: Unwanted effects? Unexpected benefits?

Your Daily Dosing DiaryPatient Name: Date: / /

Dose consumed

mL

mL

mL

mL

AM

AM

PM

PM

Time of use Comments (e.g. effects on symptoms)

The scale is from 1 to 10 with 10 indicating the best health you can imagine and 1 indicating the worst health you can imagine.

Thinking of your overall health, please indicate below how you are feeling today?

1 2 3 4 5 6 7 8 9 10

20: 5

THC Dominant

10: 10

THC/CBD Balance

1 :20

CBD Dominant

CBD

CBD 50 or 1:100

Product

Additional comments: Unwanted effects? Unexpected benefits?

Your Daily Dosing DiaryPatient Name: Date: / /

Dose consumed

mL

mL

mL

mL

AM

AM

PM

PM

Time of use Comments (e.g. effects on symptoms)

The scale is from 1 to 10 with 10 indicating the best health you can imagine and 1 indicating the worst health you can imagine.

Thinking of your overall health, please indicate below how you are feeling today?

1 2 3 4 5 6 7 8 9 10

18 1919

General Notes

20: 5

THC Dominant

10: 10

THC/CBD Balance

1 :20

CBD Dominant

CBD

CBD 50 or 1:100

Product

Additional comments: Unwanted effects? Unexpected benefits?

Your Daily Dosing DiaryPatient Name: Date: / /

Dose consumed

mL

mL

mL

mL

AM

AM

PM

PM

Time of use Comments (e.g. effects on symptoms)

The scale is from 1 to 10 with 10 indicating the best health you can imagine and 1 indicating the worst health you can imagine.

Thinking of your overall health, please indicate below how you are feeling today?

1 2 3 4 5 6 7 8 9 10

Return to page 4 ‘General Overview’ and complete your symptom(s) score for day 14.

Website littlegreenpharma.com

Email info@littlegreenpharma.com

Phone 1300 703 999

20

Resources

Dosing Diary To obtain further copies of this Dosing Diary, please visit:littlegreenpharma.com/patient-focused/dosing-diary

Medical cannabis education & resources: Visit littlegreenpharma.com and greenchoices.com.au for more information on medical cannabis.

This is an unregistered medicine manufactured to medical grade standards.Little Green Pharma Ltd. ABN 44 615 586 215.Date of preparation: June 2020.

LGP_30062020 V2

Website littlegreenpharma.com

Email info@littlegreenpharma.com

Phone 1300 703 999