Mood stabilizers Flashcards
Lithium - dose, side FX
(CARBOLITH) – start 300mg TID – (target 900-1800mg per day to keep Li level between 0.6-1.0). Check a trough level (ie. 12 hours after last night’s dose) after the patient has been on a therapeutic dose for 4-5 days. Reduces risk of suicide and death in bipolar patients.
Common adverse effects:
Longterm medical complications: renal failure, hypothyroidism, hyperparathyroidism, nephrogenic diabetes insipidus. Teratogenic (Ebstein’s anomaly).
Risks for intoxication: dehydration, renal failure, NSAIDS. Watch for renal failure, hypothyroidism (or even hyperthyroidism), polyuria, polydipsia, weight gain.
Symptoms of intoxication vary from mild (nausea, vomiting, diarrhea) to severe (confusion, ataxia, tremor… seizure—coma—death ).
Valproic acid - dose, side FX
(EPIVAL) – start at 500-750mg per day divided BID. Follow levels. Maximum 2000mg BID. The recommended range for the treatment of acute mania is 85-125 µg/mL total valproic acid (absolute max=150).
Commonly: sedation, nausea, vomiting, diarrhea, abdominal pain. Consider tremor, diplopia, hair loss. Risk of elevated liver enzymes and low platelets: monitor for 6-12 months.
Lamotrigine
(LAMICTAL) – Start at 25mg QD for 2 weeks, then increase to 50mg QD for two weeks, then increase to 100mg QD for one week then increase to 200mg (IE SLOW TITRATION to limit the chance of developing Stevens Johnson). If the patient is on valproic acid, titrate slower. If the patient is on carbamazepine, titrate faster. About 10% of patients may develop a rash but fortunately few will actually develop the potentially deadly condition. Other than the rash, this medication is usually very well tolerated with few side effects. Lamotrigine is best used in the prevention of depression.
Carbamazepine
(TEGRETOL)– start 200mg BID (maximum 1600mg per day). Nausea, vomiting, diarrhea, hyponatremia, rash, pruritus, fluid retention. There is a risk of Stevens Johnsons syndrome, neurotoxicity (drowsiness, dizziness, blurred vision, lethargy, headaches), and leukopenia/aplastic anemia. NOTE: you will rarely see this medication prescribed in psychiatry so just know it exists.
What is Stevens-Johnson syndrome?
A form of toxic epidermal necrolysis. It is a life-threatening skin condition, in which cell death causes the epidermis to separate from the dermis. The syndrome is thought to be a hypersensitivity complex that affects the skin and the mucous membranes. The most well-known causes are certain medications, but it can also be due to infections, or more rarely, cancers.
