Page 63 - e-book CPG - Bipolar Disorder

CLINICAL PRACTICE GUIDELINES MANAGEMENT OF BIPOLAR DISORDER (2ND ED.)

Therapeutic range: 50 - 125 mg/L

REMARKS Steady state: 2 - 4 days Sampling time: 30 minutes OR just before next dose Therapeutic serum levels generally occur with total daily doses of 1.5 - 2.5 g  Valproate administration may also impair fertility in men. Fertility dysfunctions are in some cases reversible at least 3 months after tr

● TDM: o o o o recommendations.

COMMON/SIGNIFICANT ADVERSE EFFECTS CNS: dizziness, drowsiness, Hematologic: thrombocytopenia, decreased platelet aggregation Liver: hepatotoxicity/hepatic failure, hyperammonaemia, hepatic encephalopathy Dermatologic: SJS, TEN, DRESS GI: abdominal pain, diarrhoea, nausea, vomiting, pancreatit

HEPATIC DOSE Severe impairment: Use is contraindicated Moderate to severe impairment WITHOUT ascites: Decrease doses by ~25% Moderate to severe impairment WITH ascites: Decrease doses by ~50% 49

RENAL DOSE CrCl <10 ml/min: No specific dosage adjustment necessary. However, free valproate clearance may be reduced up to ~30%. CrCl <30 ml/min: Titrate with caution as some pharmacokinetics parameters (e.g. half life) may vary considerably

DOSING GUIDE Acute manic or acute episodes with mixed features, depressive episodes Oral - IR: 600 mg daily and increase by 200 mg/day at 3-day interval until control is achieved. ER: 1000mg daily (in once or twice daily regimen) Usual dose range : 1000 to 2000 mg/day (i.e 20 - 30 mg/kg/day) (Ma

MEDICATION Valproate Lamotrigine

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