Article 13 - Tolerance, Titration, and Why Your Dose Changes Over Time

A dose that worked well at the beginning of treatment may not feel exactly the same months later. That does not automatically mean the medicine has stopped working or that you should increase it yourself.

Response can change for many reasons, including tolerance, symptom changes, product changes, delivery method, sleep, stress, other medicines, and individual physiology. Understanding the difference between these factors helps patients have safer and more useful conversations with their prescribing team.

What is tolerance?

Tolerance usually refers to a reduced response to a medicine after repeated use. The same dose may produce a less noticeable effect, or the effect may not last as long as it did previously.

Tolerance is not the only explanation for a change in response. A different batch, a different product, a change in device or temperature, poor storage, altered sleep, illness, stress, or a change in another medicine can all affect how treatment feels.

It is also possible for one effect to change while another remains. For example, a patient may notice less drowsiness without concluding that every intended benefit has disappeared. A careful record is more useful than relying on one difficult day.

What is titration?

Titration is the careful adjustment of a medicine to find a dose that provides an acceptable balance between benefit and unwanted effects. With prescribed cannabis-based medicines, titration should follow the plan provided by the prescribing clinician or clinic.

Titration is not a race to reach the highest possible dose. The aim is not to feel the strongest effect. The aim is to find an appropriate and sustainable treatment response while keeping risks and unwanted effects under review.

Different patients may need different doses. A dose that is suitable for one patient should not be treated as a guide for another person.

Why can dose requirements change?

The medicine or batch has changed

Two products can have similar headline cannabinoid percentages while differing in formulation, minor cannabinoids, terpene profile, preparation, or batch. Check the product name, strength, formulation, and batch information if your response changes unexpectedly.

The delivery method has changed

The route and delivery method affect how a medicine is absorbed. For vaporised products, device condition, airflow, temperature, loading, and technique can affect consistency. For oils or other formulations, timing, food, storage, and administration technique may also matter.

Your circumstances have changed

Sleep, stress, diet, illness, hydration, activity, and other medicines can change how treatment is experienced. A change in symptoms can also make an established dose feel less effective, even when the medicine itself has not changed.

Your expectations have changed

Early treatment can feel different because the patient is paying close attention to every change. Over time, a helpful effect may become less noticeable because it has become part of normal daily life. That is not the same as proof that treatment is no longer useful.

Keep a simple treatment record

A short, consistent record can help separate a pattern from a one-off experience. Consider noting:

• Product name, strength, and formulation
• Date and approximate time
• Amount used, following your prescribed plan
• Route and delivery method
• What you hoped to address
• What changed and when
• Unwanted effects
• Sleep, stress, illness, and other relevant factors

The purpose is not to turn treatment into a laboratory experiment. It is to give your prescribing team clearer information than a general statement such as “it is not working anymore.”

What not to do

Do not increase the dose repeatedly to chase a particular feeling. Do not copy another patient's dose. Do not combine prescribed medicines with alcohol or other substances without understanding the risks. Do not make a major change because of one difficult day unless your prescribing team has told you how to respond.

If you have missed doses, changed products, used a different device, or stored the medicine differently, mention that when discussing a change in response. These details may be clinically relevant.

Recognising unwanted effects

Unwanted effects can include sleepiness, dizziness, anxiety, confusion, changes in mood, impaired coordination, or other symptoms. The significance of a symptom depends on the person, medicine, dose, timing, and other health factors.

Do not drive, operate machinery, or carry out safety-critical activities if you feel impaired. Follow the advice provided by your prescribing clinician and the legal requirements that apply to you.

Seek urgent medical help if you experience severe or rapidly worsening symptoms, difficulty breathing, chest pain, loss of consciousness, severe confusion, or another emergency. For non-urgent concerns, contact your prescribing clinic, pharmacist, or usual healthcare professional.

When to speak to your prescribing team

Contact your prescribing team if the effect has changed consistently, unwanted effects are increasing, you are using more than planned, the medicine is interfering with daily activities, or you are unsure whether a product or batch has changed.

Bring your treatment record and the product packaging where possible. Ask whether the plan should remain unchanged, whether a review is needed, or whether another explanation should be considered.

The honest conclusion

Dose changes over time are not automatically a sign of failure, and they are not an invitation to self-adjust. Tolerance is one possible explanation among several. A safe approach is to observe carefully, keep the product and method consistent where possible, record meaningful changes, and discuss patterns with the clinician responsible for your treatment.

Titration should be gradual, individualised, and clinically supervised. The most useful treatment decision is not necessarily the one that produces the strongest immediate effect. It is the one that supports a sustainable balance between benefit, function, safety, and quality of life.

Sources and further reading

This article is general patient education and does not set a dose or replace prescribing instructions. For advice about your medicine, dose, side effects, or treatment plan, speak with your prescribing clinician or pharmacist.