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McNamara NA, Dang LT, Sturza J, Ziobro JM, Fedak Romanowski EM, Smith GC, Joshi SM, Leber SM, Carlson M, Robertson P, Shellhaas RA. Thrombocytopenia in pediatric patients on concurrent cannabidiol and valproic acid. Epilepsia 2020; 61:e85-e89. [PMID: 32614070 DOI: 10.1111/epi.16596] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 01/14/2023]
Abstract
In January 2019, a new plant-derived purified cannabidiol preparation, approved by the US Food and Drug Administration, became commercially available for patients ≥2 years old with Lennox-Gastaut syndrome or Dravet syndrome. Among our patients who were prescribed the new cannabidiol formulation, we observed several cases of thrombocytopenia and therefore embarked on this study. We conducted a single-center systematic chart review of all pediatric patients (<21 years old) who were prescribed cannabidiol from January to August 2019. We evaluated salient features of the patients' epilepsy syndrome, age, concurrent medications, and surveillance laboratory results before and after cannabidiol initiation. Among 87 patients, nine (10%) developed thrombocytopenia (platelet nadir range = 17 000-108 000) following initiation of cannabidiol. Each of these nine children was on combination therapy of cannabidiol with valproic acid. Whereas no children on cannabidiol without valproic acid (0/57) developed thrombocytopenia, nine of 23 treated with combination valproic acid and cannabidiol developed platelets < 110 000/µL (P < .0001). We report a novel and clinically important side effect of thrombocytopenia in one-third of patients treated concurrently with cannabidiol and valproic acid. If this finding is confirmed, clinicians should perform close monitoring for thrombocytopenia when adding cannabidiol to a regimen that includes valproic acid.
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Affiliation(s)
- Nancy A McNamara
- Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Louis T Dang
- Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Julie Sturza
- Department of Pediatrics, Department of Biostatistics and Data Management, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Julie M Ziobro
- Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Erin M Fedak Romanowski
- Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Garnett C Smith
- Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Sucheta M Joshi
- Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Steven M Leber
- Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Martha Carlson
- Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Patricia Robertson
- Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Renée A Shellhaas
- Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA
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