Page 64 - e-book CPG - Bipolar Disorder

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

REMARKS Steady state: Initiation: 2 - 3 weeks Dose adjustment: 2 - 5 days Sampling time: 0 - 30 min before dose; after steady state achieved Therapeutic range: 4 - 12 µg/ml

● TDM o o o

COMMON/SIGNIFICANT ADVERSE EFFECTS Hematologic: Aplastic anaemia, leukopenia, thrombocytopenia Cardiac: sinus tachycardia Liver: Hepatotoxicity/hepatic failure, increased serum transaminases Dermatologic: maculopapular rash, SJS, TEN, DRESS, AGEP hyponatraemia, SIADH CNS: ataxia, dizziness,

neutropenia, Electrolytes: drowsiness
HEPATIC DOSE No dosage adjustment provided in the manufacturer’s labelling. Use with caution and consider dose reduction as it is metabolised primarily in the liver. 50

RENAL DOSE No dosage adjustment necessary

DOSING GUIDE Week 1 and 2: 25 mg every other day Week 3 and 4: 25 mg once daily Week 5: 50 mg/day in 1 - 2 divided doses Week 6 and maintenance: 100 mg/day in 1 - 2 divided doses Patients taking drug(s) that induce lamotriginine metabolism but not taking valproate Week 1 and 2: 50 mg/day in 1

MEDICATION
Carbamazepine

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