{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:49:37Z","timestamp":1787014177855,"version":"build-2736575974"},"reference-count":8,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2020,7,2]],"date-time":"2020-07-02T00:00:00Z","timestamp":1593648000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"University of Michigan Charles Woodson Pediatric Research Fund"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    In January 2019, a new plant\u2010derived purified cannabidiol preparation, approved by the US Food and Drug Administration, became commercially available for patients \u22652\u00a0years old with Lennox\u2010Gastaut 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\u2010center systematic chart review of all pediatric patients (&lt;21\u00a0years old) who were prescribed cannabidiol from January to August 2019. We evaluated salient features of the patients\u2019 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\u00a0000\u2010108\u00a0000) 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\u00a0&lt;\u00a0110\u00a0000\/\u00b5L (\n                    <jats:italic>P<\/jats:italic>\n                    \u00a0&lt;\u00a0.0001). We report a novel and clinically important side effect of thrombocytopenia in one\u2010third 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.\n                  <\/jats:p>","DOI":"10.1111\/epi.16596","type":"journal-article","created":{"date-parts":[[2020,7,2]],"date-time":"2020-07-02T07:36:43Z","timestamp":1593675403000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Thrombocytopenia in pediatric patients on concurrent cannabidiol and valproic acid"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2608-5247","authenticated-orcid":false,"given":"Nancy A.","family":"McNamara","sequence":"first","affiliation":[{"name":"Division of Pediatric Neurology Department of Pediatrics Michigan Medicine Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4853-4952","authenticated-orcid":false,"given":"Louis T.","family":"Dang","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurology Department of Pediatrics Michigan Medicine Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Sturza","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Department of Biostatistics and Data Management Michigan Medicine Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie M.","family":"Ziobro","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurology Department of Pediatrics Michigan Medicine Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin M.","family":"Fedak Romanowski","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurology Department of Pediatrics Michigan Medicine Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garnett C.","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurology Department of Pediatrics Michigan Medicine Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1205-6103","authenticated-orcid":false,"given":"Sucheta M.","family":"Joshi","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurology Department of Pediatrics Michigan Medicine Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M.","family":"Leber","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurology Department of Pediatrics Michigan Medicine Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha","family":"Carlson","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurology Department of Pediatrics Michigan Medicine Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Robertson","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurology Department of Pediatrics Michigan Medicine Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3175-3908","authenticated-orcid":false,"given":"Ren\u00e9e A.","family":"Shellhaas","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurology Department of Pediatrics Michigan Medicine Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,7,2]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.5698\/1535-7511-16.4.239"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/0887-8994(96)00052-5"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30136-3"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.14670"},{"key":"e_1_2_7_6_1","unstructured":"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."},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1611618"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.14628"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/cpdd.665"}],"container-title":["Epilepsia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fepi.16596","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/epi.16596","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/epi.16596","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/epi.16596","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T06:57:38Z","timestamp":1693897058000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/epi.16596"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,2]]},"references-count":8,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2020,8]]}},"alternative-id":["10.1111\/epi.16596"],"URL":"https:\/\/doi.org\/10.1111\/epi.16596","archive":["Portico"],"relation":{},"ISSN":["0013-9580","1528-1167"],"issn-type":[{"value":"0013-9580","type":"print"},{"value":"1528-1167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,2]]},"assertion":[{"value":"2020-05-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-06-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-07-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}