دورية أكاديمية
Thrombocytopenia in pediatric patients on concurrent cannabidiol and valproic acid.
| العنوان: | Thrombocytopenia in pediatric patients on concurrent cannabidiol and valproic acid. |
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| المؤلفون: | McNamara NA; Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA., Dang LT; Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA., Sturza J; Department of Pediatrics, Department of Biostatistics and Data Management, Michigan Medicine, Ann Arbor, Michigan, USA., Ziobro JM; Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA., Fedak Romanowski EM; Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA., Smith GC; Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA., Joshi SM; Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA., Leber SM; Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA., Carlson M; Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA., Robertson P; Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA., Shellhaas RA; Division of Pediatric Neurology, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA. |
| المصدر: | Epilepsia [Epilepsia] 2020 Aug; Vol. 61 (8), pp. e85-e89. Date of Electronic Publication: 2020 Jul 02. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Blackwell Science Country of Publication: United States NLM ID: 2983306R Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1528-1167 (Electronic) Linking ISSN: 00139580 NLM ISO Abbreviation: Epilepsia Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Malden, MA : Blackwell Science Original Publication: Copenhagen : Munskgaard |
| مواضيع طبية MeSH: | Anticonvulsants/*therapeutic use , Cannabidiol/*therapeutic use , Drug Resistant Epilepsy/*drug therapy , Epilepsies, Myoclonic/*drug therapy , Lennox Gastaut Syndrome/*drug therapy , Thrombocytopenia/*epidemiology , Valproic Acid/*therapeutic use, Adolescent ; Child ; Child, Preschool ; Drug Therapy, Combination ; Epilepsy/drug therapy ; Female ; Humans ; Infant ; Male ; Young Adult |
| مستخلص: | 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. (© 2020 International League Against Epilepsy.) |
| References: | Gidal BE. Cannabidiol and epilepsy: sifting, winnowing and buzz. Epilepsy Curr. 2016;16(4):239-41. Allarakhia IN, Garofalo EA, Komarynski MA, Robertson PL. Valproic acid and thrombocytopenia in children: a case-controlled retrospective study. Pediatr Neurol. 1996;14:303-7. Thiele EA, Marsh ED, French JA, et al. Cannabidiol in patients with seizures associated with Lennox-Gastaut syndrome (GWPCARE4): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2018;391(10125):1085-96. Thiele E, Marsh E, Mazurkiewicz-Beldzinska M, et al. Cannabidiol in patients with Lennox-Gastaut syndrome: interim analysis of an open-label extension study. Epilepsia. 2019;60:419-28. US Food and Drug Administration. Epidiolex [package insert]: highlights of prescribing information. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210365lbl.pdf. Revised April 2020. Accessed June 2, 2020. Devinsky O, Cross JH, Wright S, et al. Trial of cannabidiol for drug-resistant seizures in the Dravet syndrome. N Engl J Med. 2017;376:2011-20. Devinsky O, Nabbout R, Miller I, et al. Long-term cannabidiol treatment in patients with Dravet syndrome: an open-label extension trial. Epilepsia. 2019;60(2):294-302. Morrison G, Crockett J, Blakey G, Sommerville K. Pharmacokinetic trial to investigate possible drug-drug interactions between clobazam, stiripentol, or valproate and cannabidiol in healthy subjects. Clin Pharmacol Drug Dev. 2019;8(8):1009-31. |
| معلومات مُعتمدة: | International University of Michigan Charles Woodson Pediatric Research Fund |
| فهرسة مساهمة: | Keywords: Dravet syndrome; Lennox-Gastaut syndrome; cannabidiol; intractable epilepsy |
| المشرفين على المادة: | 0 (Anticonvulsants) 19GBJ60SN5 (Cannabidiol) 614OI1Z5WI (Valproic Acid) |
| تواريخ الأحداث: | Date Created: 20200703 Date Completed: 20210122 Latest Revision: 20210122 |
| رمز التحديث: | 20221213 |
| DOI: | 10.1111/epi.16596 |
| PMID: | 32614070 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1528-1167 |
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| DOI: | 10.1111/epi.16596 |