Clinical Pharmacology of Mood Stabilizers | |
| AGENT AND DOSING | SIDE EFFECTS AND OTHER EFFECTS |
|---|---|
| Lithium | Common Side Effects |
Starting dose: 300 mg bid or tid Therapeutic blood level: 0.8-1.2 meq/L | Nausea/anorexia/diarrhea, fine tremor, thirst, polyuria, fatigue, weight gain, acne, folliculitis, neutrophilia, hypothyroidism Blood level is increased by thiazides, tetracyclines, and NSAIDs Blood level is decreased by bronchodilators, verapamil, and carbonic anhydrase inhibitors Rare side effects: Neurotoxicity, renal toxicity, hypercalcemia, ECG changes |
| Valproic Acid | Common Side Effects |
Starting dose: 250 mg tid Therapeutic blood level: 50-125 µg/mL | Nausea/anorexia, weight gain, sedation, tremor, rash, alopecia Inhibits hepatic metabolism of other medications Rare side effects: Pancreatitis, hepatotoxicity, Stevens-Johnson syndrome |
| Carbamazepine/Oxcarbazepine | Common Side Effects |
Starting dose: 200 mg bid for carbamazepine, 150 mg bid for oxcarbazepine Therapeutic blood level: 4-12 µg/mL for carbamazepine | Nausea/anorexia, sedation, rash, dizziness/ataxia Carbamazepine, but not oxcarbazepine, induces hepatic metabolism of other medications Rare side effects: Hyponatremia, agranulocytosis, Stevens-Johnson syndrome |
| Lamotrigine | Common Side Effects |
| Starting dose: 25 mg/d | Rash, dizziness, headache, tremor, sedation, nausea Rare side effect: Stevens-Johnson syndrome |