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Sativex Buccal Spray is indicated for neuropathic pain in MS patients over 18 years of age. Each spray contains delta-9-tetrahydrocannabinol 27 mg/mL (from Tetranabinex—Cannabis sativa L. extract) and cannabidiol 25 mg/mL (from Nabidiolex—Cannabis sativa L. extract) in a 5.5 ml vial delivering 51 sprays. Target area is under the tongue or inside of cheek. Shake before use. The spray is refrigerated until open then at room temperature for 28 days. First day dosage is one spray every 4 hours (max 4 sprays). Adjust upward when necessary but average is 5 sprays per day. Maximum 12 sprays per day should not be exceeded. THC is a psychotropic agent which may produce physical and psychological dependence and has the potential to be abused. Relevant for pain modulation, Cannabinoid receptors are found on pain pathways in the brain and spinal cord, as well as on terminals of peripheral nervous system primary afferent neurons where they mediate cannabinoid-induced analgesia. THC can result in changes of mood, decrease in cognitive performances and memory, decrease in ability to control drives and impulses, and alteration of the perception of reality, particularly altered time sense. Fainting episodes have been observed with use of SATIVEX. Cannabinoids have cardiovascular effects that include tachycardia, and transient changes in blood pressure, including episodes of postural hypotension. Use of SATIVEX is not recommended in patients with pre-existing cardiovascular disease, such as ischaemic heart disease, arrhythmias, poorly controlled hypertension or severe heart failure.