Nabiximols (Sativex) is approved in 30+ countries for MS spasticity — the strongest regulatory evidence in cannabis medicine.
Multiple sclerosis (MS) is an autoimmune disease affecting 1 million Americans in which the immune system attacks myelin, disrupting nerve signal transmission. Spasticity, pain, bladder dysfunction, and fatigue are the most disabling symptoms. Nabiximols (THC:CBD 1:1 oromucosal spray, marketed as Sativex) is approved in 30+ countries for MS spasticity refractory to conventional treatment.
1 million
Americans Affected
0.3% of U.S. population
Prevalence
1
Key Studies
3
Cannabinoids Reviewed
The endocannabinoid system modulates neuroinflammation, neuroprotection, and spasticity — all central to MS pathology. A Phase 3 RCT (n=572) found nabiximols produced a 74.6% responder rate for spasticity vs. 51.2% placebo. CBD's neuroprotective and anti-inflammatory properties may slow disease progression in preclinical models.
CB1 receptors on GABAergic and glutamatergic neurons in the spinal cord regulate muscle tone. THC activation of CB1 reduces the excessive excitatory signaling that drives spasticity in MS, producing muscle relaxation without the sedation of baclofen or tizanidine.
CB2 receptors on microglia and astrocytes regulate neuroinflammation. CBD and THC activation of CB2 reduces microglial activation and pro-inflammatory cytokine release, potentially slowing the neuroinflammatory damage that drives MS progression.
CB1 receptors in the bladder and urethra regulate detrusor muscle activity. Cannabinoids reduce bladder overactivity and urge incontinence — a significant quality-of-life issue in MS. Clinical trials of nabiximols have shown improvements in bladder symptoms alongside spasticity.
MS neuropathic pain involves central sensitization driven by demyelination and neuroinflammation. Cannabinoids modulate pain at multiple levels — peripheral CB1/CB2, spinal cord, and supraspinal — providing analgesia for the complex pain syndromes of MS.
Nabiximols (Sativex) — 2.7mg THC + 2.5mg CBD per spray — is approved in 30+ countries for MS spasticity. Phase 3 RCT: 74.6% responder rate.
CBD's neuroprotective and anti-inflammatory properties are relevant to MS pathology. Human trials for disease modification are ongoing.
THC is the primary active component for spasticity reduction. Dose-dependent psychoactivity requires careful titration.
Nabiximols for MS Spasticity: Phase 3 RCT
Nabiximols produced 74.6% responder rate (≥20% spasticity improvement) vs. 51.2% placebo (p<0.0001) in 572 MS patients.
Dosing information is for educational purposes only. Always start with the lowest effective dose and consult a healthcare provider before use.
Start Dose
1 spray (2.7mg THC / 2.5mg CBD)
Target Dose
8–12 sprays/day
Timing
Titrate over 2 weeks; spread throughout day
Prescription only. Available in 30+ countries. Titrate slowly to minimize psychoactive effects.