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FDA approved for bipolar disorder maintenance therapy, not for acute mood problems like depression or mania/hypomania. [10] The usual target dose is 100–200 mg daily, titrated to by 25 mg increments every 2 weeks. [11] Lamotrigine can cause Stevens–Johnson syndrome, a very rare but potentially fatal skin condition. [10] Carbamazepine
Continuing the maintenance dose for about 4 to 5 half-lives (t 1/2) of the drug will approximate the steady state level. [1] One or more doses higher than the maintenance dose can be given together at the beginning of therapy with a loading dose. [2] A loading dose is most useful for drugs that are eliminated from the body relatively slowly ...
A variety of other agents have been tried in bipolar disorder, including benzodiazepines, calcium channel blockers, L-methylfolate, and thyroid hormone. [2] Modafinil (Provigil) and pramipexole (Mirapex) have been suggested for treating cognitive dysfunction associated with bipolar depression, but evidence supporting their use is quite limited.
In adult patients taking valproate alone, 30–50% of an administered dose is excreted in urine as the glucuronide conjugate. [68] The other major pathway in the metabolism of valproate is mitochondrial beta oxidation, which typically accounts for over 40% of an administered dose. [ 68 ]
In those with bipolar disorder, quetiapine is used to treat depressive episodes; acute manic episodes associated with bipolar I disorder (as either monotherapy or adjunct therapy to lithium; valproate or lamotrigine); acute mixed episodes; and maintenance treatment of bipolar I disorder (as adjunct therapy to lithium or divalproex).
Data from studies conducted on women taking antiepileptic drugs for non-epileptic reasons, including depression and bipolar disorder, show that if high doses of the drugs are taken during the first trimester of pregnancy then there is the potential of an increased risk of congenital malformations. [102]
The formula for determining the dose is: [1] If there is a single recommended maintenance dose in the literature, this is preferred. If there are a range of recommended maintenance doses then If the literature recommends generally increasing from initial to maximum dose provided it is tolerated, pick the maximum dose.
Research has investigated the use of oxcarbazepine as a mood stabilizer in bipolar disorder, with further evidence needed to fully assess its suitability. [7] [29] [30] [31] Oxcarbazepine used in conjunction with lithium has been shown to be effective in the maintenance phase. [32] It may be beneficial in trigeminal neuralgia. [33]
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