NIMH » Mental Health Medications Acute and maintenance treatment of manic or mixed episodes associated with bipolar I disorder, either as monotherapy or as adjunct to lithium or valproate Monotherapy: 15 mg/day PO initially; may be increased gradually; not to exceed 30 mg/day Adjunct to lithium or valproate: 10-15 mg/day PO initially; recommended daily dose is 15 mg/day; may be gradually increased; not to exceed 30 mg/day Continue stabilization dose for up to 6 weeks; treatment Coadministration with potent CYP2D6 or CYP3A4 inhibitors: Decrease dose by 50% Coadministration with potent CYP2D6 inhibitor PLUS a potent CYP3A4 inhibitor: Decrease dose to 25% of the usual dose (ie, decrease dose by 75%) Coadministration with any CYP2D6 inhibitor PLUS any CYP3A4 inhibitor: Decrease dose to 25% of the usual dose (ie, decrease dose by 75%) initially, and then adjust to a favorable clinical response Poor CYP2D6 metabolizers: Decrease dose by 50% initially, and then adjust to a favorable clinical response Poor CYP3A4 metabolizers: Decrease dose to 25% of the usual dose (ie, decrease dose by 75%) initially, and then adjust to a favorable clinical response Coadministration with potent CYP3A4 inducer: The usual dose should be doubled 13-17 years: 2 mg/day PO initially; increased to 5 mg/day after 2 days; increased to recommended dosage of 10 mg/day after additional 2 days; may subsequently be increased by 5 mg/day; maintenance: 10-30 mg/day Acute manic or mixed episodes, either as monotherapy or as adjunct to lithium or valproate 10-17 years: 2 mg/day PO initially; increased to 5 mg/day after 2 days; increased to recommended dosage of 10 mg/day after additional 2 days; may subsequently be increased by 5 mg/day; maintenance: 10-30 mg/day Coadministration with potent CYP2D6 or CYP3A4 inhibitors: Decrease dose by 50% Coadministration with potent CYP2D6 inhibitor PLUS a potent CYP3A4 inhibitor: Decrease dose to 25% of the usual dose (ie, decrease dose by 75%) Coadministration with any CYP2D6 inhibitor PLUS any CYP3A4 inhibitor: Decrease dose to 25% of the usual dose (ie, decrease dose by 75%) initially, and then adjust to a favorable clinical response Poor CYP2D6 metabolizers: Decrease dose by 50% initially, and then adjust to a favorable clinical response Poor CYP3A4 metabolizers: Decrease dose to 25% of the usual dose (ie, decrease dose by 75%) initially, and then adjust to a favorable clinical response Coadministration with potent CYP3A4 inducer: The usual dose should be doubled Dizziness (10%) Dyspepsia (9%) Somnolence (5-8%) Fatue (6%) Restlessness (6%) Tremor (6%) Dry mouth/xerostomia (5%) Extrapyramidal disorder (5%) Orthostatic hypotension (1-5%) Musculoskeletal stiffness (4%) Abdominal discomfort (3%) Blurred vision (3%) Cough (3%) Pain (3%) Myalgia (2%) Rash Rhinitis Not approved for dementia-related psychosis; patients with dementia-related psychosis who are treated with antipsychotic drugs are at increased risk of death, as shown in short-term controlled trials; deaths reported in trials appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature In short-term studies, antidepressants increased risk of suicidal thinking and behavior in children, adolescents, and young adults ( Risk of NMS and extrapyramidal symptoms (EPS) Tardive dyskinesia may occur; may consider discontinuation of therapy if cliniy indicated Use caution in patients with known cardiovascular disease, cerebrovascular disease, or predisposition to hypotension; may increase incidence of cerebrovascular adverse reactions (e.g., stroke, transient ischemic attack, including fatalities) Monitor heart rate and blood pressure and warn patients with known cardiovascular or cerebrovascular disease, and risk of dehydration or syncope Use caution in patients with Parkinson disease; may aggravate motor disturbances May increase risk of suicidal tendencies in children and adolescents FDA warning regarding off-label use for dementia in elderly Patients may act on dangerous impulses Leukopenia/neutropenia and agranulocytosis reported; possible risk factors for leukopenia/neutropenia include preexisting low white blood cell (WBC) count and history of drug-induced leukopenia/neutropenia If patient has history of cliniy snificant low WBC count or drug-induced leukopenia/neutropenia, monitor complete blood count (CBC) frequently during first few months of therapy; discontinue drug at first sn of cliniy snificant WBC decline Pregnancy category: C Neonates exposed to antipsychotic drugs during 3rd trimester of pregnancy are at risk for EPS or withdrawal symptoms after delivery; these complications vary in severity, with some being self-limited and others requiring ICU support and prolonged hospitalization Lactation: Excreted in human breast milk; a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother Do not confuse IM long-acting depot suspension for maintenance of schizophrenia with the IM solution for acute agitation in patients with schizophrenia or mania Reconstitute lyophilized power with sterile water for injection (SWI); discard any unused portion of diluent 400 mg/vial: 1.9 m L SWI 300 mg/vial: 1.5 m L SWI Final concentration for either vial is 200 mg/m L following reconstitution Slowly inject SWI into vial, and then withdraw air from vial to equalize the pressure Shake the vial vorously for 30 seconds until the reconstituted suspension appears uniform Visually inspect for particulate matter and discoloration; should appear as a uniform, homogeneous suspension that is opaque and milky-white in color Do not store reconstituted suspension in syringe Use BD Leur-Lok syringe (provided in kit) to remove the vial adapter from the package and discard the vial adapter package Determine recommended volume for injection to provide appropriate dose Attach adapter-syringe to vial and pushing adapter’s spike firmly through the rubber stopper until it snaps in place Slowly withdraw the dosage volume into the syringe Remove BD Leur-Lok syringe and select appropriate size hypodermic needle Tap the syringe on your palm at least 10 times to dislodge any material which may have settled, and then shake the syringe vorously for a minimum of 30 seconds to ensure a uniform suspension; if the syringe is not used within 15 minutes, shake again for 30 seconds Attach appropriate needle with a clockwise twisting motion; do not overthten (could lead to needle hub cracking) Prime syringe to remove air by bringing the syringe into uprht position and tap the syringe to bring air to the top; remove air by depressing the plunger rod; a few drops of suspension will be released Administer the entire content IM; inject in a rapid and continuous manner in The above information is provided for general informational and educational purposes only. Explore basic information and resources on mental health medications, including antidepressants, anti-anxiety medications, stimulants, antipsychotics, and.
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