Lamotrigine and COVID-19 Vaccine: A Case of Leukopenia

Leukopenia, a condition characterized by a decrease in white blood cell count, is a medical phenomenon that warrants attention, especially when linked to the initiation of medications. In a newly published case report, a 20-year-old bipolar woman experienced leukopenia following the administration of lamotrigine, next day after COVID-19 vaccine booster, shedding light on potential risks and interactions.

Lamotrigine is known for its efficacy in treating bipolar disorder, but like any medication, it comes with potential side effects. Adverse effects are more likely when lamotrigine is used alongside other antiepileptic drugs, during rapid dose titration, or in combination with multiple medications. Monitoring its concentration becomes crucial in such cases, as highlighted in this report.

The patient in question received lamotrigine the day after her third mRNA vaccination for COVID-19, presenting with predisposing factors such as concomitant use of antiepileptic drugs. Surprisingly, leukopenia manifested on day 12, without a rapid increase in lamotrigine concentration. Leukocytes gradually recovered over 22 weeks, even without discontinuation of lamotrigine. Notably, the second mRNA vaccination did not induce leukopenia.

This case report suggests potential synergistic immune response triggered by the concurrent administration of lamotrigine and mRNA vaccination, culminating in leukopenia. The gradual recovery observed aligns with the hypothesis that as the immune response wanes, the leukocyte count normalizes. This underscores the need for cautious consideration when initiating lamotrigine immediately after mRNA vaccination, recognizing it as a potential risk factor for leukopenia.

The integration of pharmacogenomic insights into clinical practice emerges as a crucial avenue for enhancing patient safety. One example is the genetic variation of NUDT15, especially prevalent in Asian populations, exerting a significant influence on an individual's susceptibility to thiopurine-induced myelotoxicity, including leukopenia. The proven utility of NUDT15 genotyping as a pharmacogenomic test for thiopurines, marked by its approval for reimbursement in Japan in February 2019, underscores its preventive impact. This test has demonstrated its efficacy in averting hospitalizations, exemplifying the tangible benefits of incorporating pharmacogenomic considerations into patient care.

REFERENCE

Murata T, Uno K, Ito M, Nagamine T. Leukopenia associated with lamotrigine initiation after COVID-19 vaccine booster: A case report and literature review. Int J Clin Pharmacol Ther. 2023 Nov 9. doi: 10.5414/CP204452. Epub ahead of print. PMID: 37942926.

Comments

Post a Comment

Popular posts from this blog

A New Onset of Ulcerative Colitis post-2nd-breakthrough-COVID-19

Image
A 21-year-old non-smoking Caucasian male with a history of acute pancreatitis but no other medical issues or family history had two doses of the BNT162b2 mRNA COVID-19 vaccine.  Four months after the second dose he had his first episode of COVID-19. Although not hypoxic, he felt pretty unwell for a week, with a severe cough, fever, generalized body ache, headache, and loss of taste. He received the third dose of the vaccine two months after recovering from COVID. Nine months after the third dose, he had the second episode of COVID-19, during which he was mildly unwell for three days, recovered, and did not require any anti-viral medication or antibiotics. One week post the second episode of COVID-19, he developed diarrhea and abdominal pain. It then progressed to bloody diarrhea. Ulcerative colitis was diagnosed based on his clinical symptoms, biopsy changes, and the exclusion of other causes.  There are ten published case reports about the newly diagnosed ulcerative colitis ...
Read more

COVID in May

Image
Concerns about a potential resurgence of COVID-19 are mounting as summer 2024 approaches.  This is driven by several indicators, including social media posts, healthcare data, and wastewater surveillance across different regions. Our study findings corroborate this trend.  While many forecasters anticipate a surge, others expect a gradual increase through the end of May, and then a decline again around early June. Reports from social media suggest emerging clusters of COVID-19 in Texas, several Canadian provinces, the UK, and on cruises in northern regions such as a Norwegian cruise to Alaska.  Data from Alberta's Respiratory virus dashboard   (total weekly laboratory-confirmed COVID-19 cases) and wastewater surveillance in Calgary indicate an uptick in COVID-19 cases starting April 2024. The most recent statistics from Alberta Health reveal a significant increase in hospitalizations due to COVID-19, with 114 individuals currently hospitalized—an incr...
Read more

Chronic SARS-CoV-2 Shedding

Image
Chronic viral shedding, a condition where the virus continues to be released from an individual's body long after the initial infection, has been observed in many infectious diseases, including COVID-19.  In such cases, individuals may remain asymptomatic or experience only mild symptoms while the virus persists. It remains detectable in repeated tests over an extended period and can still infect others even in nasal swab is negative (which happens quite often ). This was evident in our study.    Recent research by Conway et al. (2024) highlights the possibility of chronic SARS-CoV-2 infection, extending over several months and potentially years. Other studies have documented prolonged asymptomatic infections and extended viral shedding in moderate to severe beyond hospital discharge. Analysis of sequencing data on UK samples taken between 2 November 2020 and 15 August 2022 lead to estimates that 0.1–0.5% of infections may become persistent with typically rebounding high ...
Read more