Mood Stabilizer Tips

Marion Eakin and George Papakostas

Checking blood levels

· Lab work is required for lithium, valproic acid, carbamazapine

· Levels of lithium, valproic acid, carbamazapine should be drawn at trough, i.e. ~ 11-12 hours post last dose and prior to next dose.

· Have patients delay their a.m. dose until after blood is drawn.

· After a dose change, allow 3-5 days to reach steady state (depends on t ½)

Drug interactions and toxicity

· Carbamazapine has many drug-drug interactions, check PDR before prescribing

· Avoid combination of carbamazapine + clozapine (Clozaril): increased risk of agranulocytosis

· 1-3/1000 patients develop a potentially life-threatening rash on lamotrigine (Stevens-Johnson, toxic epidermal necrolysis etc.)

· Valproic acid will increase level and half-life of lamotrigine by 2, increasing risk of life-threatening rash associated with lamotrigine.

Lamotrigine and Gabapentin

Marion Eakin and George Papakostas