lithiumMood stabilizerBrands: LITHOBID | Acute manic and maintenance treatment of bipolar I disorder. View labelExact | Acute mania: typical starting doses are 600–900 mg/day divided BID/TID, titrated to serum 0.8–1.2 mEq/L (12-hour trough). Typical total daily dose is 1,200–1,800 mg/day. | Modulates second messenger systems; neuroprotective/neurotrophic effects (exact mechanism not fully known). | Not metabolized | Steady-state mean 24 h | 0.6–1.2 mEq/L | | - Baseline: BMP (BUN/Cr), electrolytes, TSH, pregnancy test if relevant, weight/BMI.
- Level timing: 12-hour trough (or pre-morning dose if BID).
- Level cadence: 5–7 days after each dose change; then every 3–6 months when stable.
- Lithium levels are typically rechecked after dehydration/illness or when starting or stopping interacting medications (NSAIDs, ACE inhibitors/ARBs, thiazides), often within 5–7 days of the change.
- Ongoing: Periodic renal and thyroid function, with assessment for toxicity symptoms.
- Periodic calcium monitoring (hyperparathyroidism risk) and follow-up for urine concentrating symptoms (polyuria/polydipsia) are often part of long-term therapy.
- Education often emphasizes hydration, consistent salt intake, and key interactions (NSAIDs/ACE inhibitors/diuretics).
| No | 2026-02-22 |
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| Acute mania associated with bipolar disorder; seizures (various types). View labelExact | Acute mania: initiate 750–1,000 mg/day (divided TID for DR or once daily ER) and titrate to serum 50–125 µg/mL; loading up to 20–30 mg/kg/day can achieve rapid control. | Increases GABA; modulates voltage-gated sodium and calcium channels. | UGT, beta-oxidation | Steady-state mean 12 h | 50–125 µg/mL | | - Baseline: LFTs, CBC with platelets, pregnancy test if relevant, weight/BMI.
- Level timing: 12-hour trough (extended-release may differ); target 50–125 µg/mL based on clinical context.
- Ongoing: Periodic LFTs and CBC; monitor metabolic effects and sedation.
- Precautions: Reinforce teratogenicity counseling; review pancreatitis and hepatotoxicity warnings.
- Drug interactions: Adjust for enzyme induction (UGT), lamotrigine titration, and other interacting therapies.
| No | 2026-03-31 |
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| Schizophrenia; acute manic or mixed episodes of bipolar I disorder (monotherapy or adjunct to lithium/valproate); maintenance therapy via LAI formulations; adjunctive treatment of major depressive disorder; irritability in autistic disorder; Tourette disorder. View labelExact | Schizophrenia (adults): start 10–15 mg once daily; therapeutic range 10–30 mg/day. Doses above 30 mg rarely add benefit. | Dopamine D2/D3 partial agonist with 5-HT1A partial agonism and 5-HT2A antagonism, stabilizing dopaminergic tone with comparatively low metabolic and EPS burden.
| CYP2D6, CYP3A4 | Steady-state mean 75 h; Steady-state range 75–146 h | 120–270 ng/mL | | - Metabolic: weight/BMI, fasting glucose/HbA1c, and lipids (baseline and periodic).
- EPS: monitor akathisia/parkinsonism; periodic AIMS for tardive dyskinesia.
| Monthly (q4wk); q4–8wk (varies by strength); Every 2 months (q8wk) | 2025-12-28 |
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| Schizophrenia; acute manic/mixed episodes; bipolar depression; adjunct for major depressive disorder. View labelExact | Schizophrenia (IR): day 1 25 mg BID, titrate to 300–400 mg/day by day 4; maintenance 300–800 mg/day divided BID. | Antagonist at 5‑HT2A and D2 (transient), strong H1 and alpha‑1 activity. | CYP3A4 | Steady-state mean 6 h | No | | - Metabolic: weight/BMI, fasting glucose/HbA1c, and lipids (baseline and periodic).
- Sedation: assess next-day impairment and fall risk, especially with other sedatives.
| No | 2025-09-23 |
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