Mood Stabilizers & Adjunct Agents
MOOD STABILIZERS & ADJUNCT AGENTS © www.RxFiles.ca Brent Jensen BSP Jun 13 Generic/Form SIDE EFFECTS MONITOR COMMENTS/ DRUG INTERACTIONS INITIAL & USUAL DOSE $ TRADE g=generic avail. Q6-12 Months DRUG LEVEL MAX DOSE RANGE /100day Common: GI N/V, drowsy, dizzy, unsteady, CBC,Platelets, √ BPAD -acute mania, rapid cycle, ↑ Carbamazepine level by: 200mg po bid 24 Carbamazepine(CBZ) cimetidine, clarithro/erythromycin, danazol, 200mg hs pruritic rash<10% may cross react with phenytoin & phenobarb; TSH,LFT, mixed & prophylaxis TEGRETOL g diltiazem, felodipine,fluoxetine, fluvoxamine, 200mg CR bid 36 dose related GI/CNS ς ς ↓WBC . CR tab: less SE . grapefruit juice, isoniazid, ketoconazole, 1800mg/day Lytes, √ trigeminal neuralgia, seizures (100 ,200 mg chew tab) 200mg po tid 33 ς ς lamotrigine, metronidazole, nefazodone, Rare: aplastic anemia, ↑ liver enzymes, Level Option for aggressive patients & (autoinduction of (200 ,400 mg CRtab) phenobarbital, propoxyphene, ritonavir,verapamil 400mg po bid 42 (200ς mg tab) heart abnormalities, ↓ serum sodium/Vit K, those with neurologic dx. & valproate P450 system complete in 4 weeks; 400mg CR bid 64 ( susp) P1,P2‐3 L / porphyria ↓ Carbamazepine level by: 20mg/ml SLE, exfoliative dermatitis, ocular effects, ECG for pts CI: hepatic dx; safe in renal dx may start low-dose & Pregnancy category→ Malformation <5% 2% phenytoin,phenobarb,St.Johns 600mg po hs 33 ? cleft palate, spina bifida OR=2.6, but ↓WBC (persistent ), ↓ T3/T4, alopecia, >45yrs 17-54 umol/l wort,theophylline ↑ weekly x4 weeks; HLA-B* 1502 HLA-A* 3101 baseline 1:1000. ↑↑ with DVA. Asian & ; Caucasian & : ↑↑risk skin rx. Wait until after auto-induction phase (4wks)! Carbamazepine ↓ levels of: Valproate also ↓’s SE.
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