The Research
In a study of pediatric patients with Dravet’s syndrome epilepsy, high doses of a hemp-derived compound with a ratio of CBD:THC of 50:1 caused a mild, transient thrombocytopenia (decreased platelet levels).1 However, this only occurred if the child was also on Valproate (a form of valproic acid used as an anticonvulsant). The amount of CBD/THC being and the length of the transient thrombocytopenia was not specified but all patients platelet counts returned to normal while in the study and on the therapy. The severity of the thrombocytopenia was mild and caused no symptoms in the patients. The amounts of CBD being given during this study were high, starting at 2mg/kg and increasing weekly to 16mg/kg. This is a very high dose of CBD to be giving to a child. For example, a 44 pound child would start at 20mg twice a day and go up to 320mg twice a day.
The cause of the transient thrombocytopenia is unknown. However, high doses of high CBD/low THC compounds can cause Drug-Drug Interactions (DDI) by interferring with the metabolism of other drugs that are metabolized by the CYP450 enzyme systems in the liver.2 Valproic acid (VA) is metabolized via the CYP450 system, however, only about 10% of is metabolized via this this route with the majority metabolized via glucouronidation and oxidation in the mitochondria, which is not known to be affected by CBD or THC.3 VA is known to cause immune thrombocytopenia and the risk of developing it is increased as the blood level of VA increases and when it is administered with other drugs.4,5 In addition, VA is known to elevate liver enzymes, an indicator of liver damage. (Gaston 2017) Therefore, the mechanism for the transient thrombocytopenia in the above study was very likely the combination of High CBD and VA levels and their concomitant effects. However, synthetic THC has been reported to cause immune thrombocytopenia, so effect of THC in this situation cannot be dismissed completely at this time.5,6
(For more info on DDI See upcoming blog: “Can CBD cause liver abnormalities?”)
Clinical Significance
The incidence of the thrombocytopenia was small and limited to a specific set of patients—all the patients were pediatric, had epilepsy, and were on Valproate. In addition, the thrombocytopenia was transient and resolved and created no symptoms. Therefore, the clinical significance of this occurrence is only academic at this time.
Bottom Line
High doses of a high CBD/low THC compound may cause transient thrombocytopenia in pediatric patients with Dravet’s syndrome who are also on Valproate and is probably due to the combination of the effects of high CBD and VA levels. There is no credible evidence of thrombocytopenia occurring in another situations with CBD isolate or with high CBD/low THC compounds given in high or low doses.
References
- McCoy B, Wang L, et al. A prospective open-label trial of a CBD/THC cannabis oil in dravet syndrome. Ann Clin Trans Neurology 2018:5(9):1077-88.
- Gaston TE, etal. Interactions between cannabidiol and commonly used antiepileptic drugs. Epilepsia. 2017 Sep;58(9):1586-1592.
- Ghodke-Puranik Y, etal. Valproic acid pathway: pharmacokinetics and pharmacodynamics. Pharmacogenet Genomics. 2013 April ; 23(4): 236–241.
- Buoli M, etal. The Risk of Thrombocytopenia During Valproic Acid Therapy: A Critical Summary of Available Clinical Data. Drugs R D. 2018 Mar;18(1):1-5.
- Ko CH, Kong CK, Tse PW. Valproic acid and thrombocytopenia: cross-sectional study. Hong Kong Med J. 2001 Mar;7(1):15-21.
- Castaneira G, Rojas K, etal. Idiopathic thrombocytopenia purpura induced by synthetic cannabinoid. J Addict Med 2018:Nov 29.
- Öztürk E, etal. Synthetic marijuana “K2” induced ITP. Platelets. 2015;26(3):258-9.
Dr. Kaufmann, this is fantastic! I love how we can reach out to you about a question or comment that a customer makes and your follow up is “On Point”. We also finished our Chapters in our ECS Primer! Your content is easy to follow and very informative! Thanks for all you do for all of us at CBD American Shaman!
I dugg some of you post as I cerebrated they were very beneficial very helpful.
My spouse and I stumbled over here different web
page and thought I might as well check things out. I like what I see so now i am following you.
Look forward to going over your web page yet again.
It’s a pity you don’t have a donate button! I’d most certainly donate to this superb blog!
I guess for now i’ll settle for bookmarking and adding your RSS feed
to my Google account. I look forward to new updates and will
talk about this blog with my Facebook group. Talk soon!
Informative article, totally what I was looking for.
Unquestionably believe that which you said. Your favorite justification appeared to be on the web the simplest thing to be aware of.
I say to you, I certainly get irked while people consider worries that they plainly don’t know
about. You managed to hit the nail upon the top and also defined out the whole thing without having side effect , people
could take a signal. Will probably be back to get more.
Thanks
There is certainly a great deal to find out about this issue.
I really like all of the points you made.
This web site really has all the info I wanted about this subject
and didn’t know who to ask.
Really good visual appeal on this internet site, I’d rate it 10.
I like this web blog it’s a master piece! Glad I noticed this on google.
It’s hard to find well-informed people about this topic, but you
sound like you know what you’re talking about!
Thanks
You can definitely see your expertise within the article you write.
The arena hopes for more passionate writers such as you who aren’t afraid
to say how they believe. All the time follow your heart.
Hello.This post was extremely remarkable, particularly since I was browsing for thoughts on this matter last
Saturday.
Hi colleagues, fastidious piece of writing and fastidious urging commented at this place, I am in fact enjoying by these.
I’ve been browsing online more than 4 hours today, yet I never found any
interesting article like yours. It’s pretty worth enough for me.
In my view, if all webmasters and bloggers made good content
as you did, the web will be much more useful than ever before.
Hello There. I found your blog using msn. This is an extremely well written article.
I’ll make sure to bookmark it and come back to read
more of your useful info. Thanks for the post. I’ll certainly return.
I like looking through a post that will make men and women think.
Also, thank you for permitting me to comment!
I like looking through a post that will make people think.
Also, thanks for allowing me to comment!
I think this is among the most vital info for me. And i am glad reading your article. But want to remark on some general things, The website style is ideal, the articles is really nice : D. Good job, cheers
Thanks to my father who shared with me concerning this blog, this blog is genuinely awesome.