Meql maintenance usual dose is 900 mgday usual range

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Levels:0.81.5 mEq/L Maintenance: Usual dose is 900 mg/day. Usual range = 9002400 mg per day in 24 divided doses, preferably with meals. Levels:0.61.2 mEq/L Renal function (BUN & SCr) baseline, at 3 months, at 6 months, then annually. Serum electrolytes baseline, then annually. Serum calcium baseline, 26 weeks after initiation, then every 612 months. Thyroid (T3, T4, TSH) baseline, at 6 months, then annually. ECG w/ rhythm strip baseline if > 40 years old or risk factors for CV disease. CBC w/ diff baseline and as clinically indicated. Weight baseline, then annually. Baseline pregnancy test in females. Serum lithium levels twice weekly until stable, then repeat every 13 months. VALPROATE/DEPAKENE® and others Levels drawn: On days 45 from initiation; in the morning,1012 hours post-dose. 750 mg/day in divided doses, adjusting dose as rapidly as possible to desired clinical effect. ER:25 mg/kg/day once daily adjusted to desired clinical effect. Maximum dose:60 mg/kg/day Levels:50120 mcg/mL Liver enzymes baseline and frequently during the first 6 months. CBC w/ platelets baseline, then every 612 months. Weight baseline, then at 6 months. Serum ammonia baseline and if symptoms of lethargy or mental status change. Baseline pregnancy test in females. Serum valproate levels until stable, then annually. CARBAMAZEPINE/TEGRETOL®Levels drawn: On days 25 from initiation; in the morning,1012 hours post-dose. Initially 200 mg twice daily; increase every 34 days by 200 mg. Usual range = 6001600 mg/day in divided doses. Levels: 812 mcg/mL CBC w/ platelet count & differential baseline, at 6 months. LFTs baseline, at 6 months. ECG baseline. Weight baseline, at 6 months. Monitor for rashes and skin reactions. Baseline pregnancy test in females. Serum carbamazepine levels repeat every 13 months for 6 months, then annually. LAMOTRIGINE1/ LAMICTAL® Weeks 1 and 2:25 mg once daily Weeks 3 and 4:50 mg once daily Week 5:100 mg once daily Week 6 and maintenance:200 mg once daily Close periodic assessments for dermatologic side effects. Serum levels not necessary. 1Lamotrigine dosing will be different if patient also taking valproic acid, carbamazepine, phenytoin, phenobarbital, primidone, rifampin, or lopinavir/ritonavir.
Federal Bureau of Prisons Management of Bipolar Disorder Clinical Guidance March 2016 34 APPENDIX 3.SIDE EFFECTS OF MOOD STABILIZERSDRUGCOMMON SIDE EFFECTSSERIOUS SIDE EFFECTSLITHIUMGI upset Hand tremor/shakiness Polyuria/polydipsia Weight gain Dermatological effects Cardiac effects (benign and reversible) Nephrogenic diabetes insipidus Hypothyroidism Leukocytosis CARBAMAZEPINEGI upset Dizziness/orthostasis Somnolence Anticholinergic side effects Diplopia Agranulocytosis Aplastic anemia SJS/TEN Hepatic failure Dermatitis/rash Serum sickness Pancreatitis Lupus syndrome LAMOTRIGINEGI upset Sedation Headache Dizziness Diplopia Blurred vision Ataxia SJS/TEN Multi-organ hypersensitivity

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