Page 67 - e-book CPG - Bipolar Disorder

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

● Take at bedtime to help reduce daytime sedation ● Only oral formulations registered with NPRA

REMARKS

COMMON/SIGNIFICANT ADVERSE EFFECTS CNS: akathisia, extrapyramidal reaction, parkinsonism, somnolence Psychiatric: anxiety Cardiac: orthostatic hypotension, peripheral oedema Endocrine and metabolic: hypercholesterolaemia, hyperglycaemia, hyperprolactinaemia, increased appetite, hypertrigly

HEPATIC DOSE When used in combination with fluoxetine: Initial: 2.5 - 5 mg daily No adjustment provided in the manufacturer’s labelling. Child-Pugh class A and B: Initial: 25 mg once daily; may increase by 53

RENAL DOSE No dosage adjustment necessary CrCl 50 - <80 ml/min: Initial: 3 mg OD Max: 6 mg OD CrCl 10 - <50 mL/min: Initial: 1.5 mg OD Max:3 mg OD CrCl <10 mL/min: Not recommended No dosage adjustment necessary

DOSING GUIDE Acute mixed or manic episodes Oral - Initial: 10 - 15 mg once daily, titrate in increment of 5 mg at intervals of >1 day (Max dose: 20 mg/day) Acute depressive episode Oral - Initial: 5 mg once daily; titrate in increment of 5 mg every 1 - 7 days (Max dose: monotherapy = 20 mg/d

MEDICATION Olanzapine Paliperidone Quetiapine IR -

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