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Plasma levels Bipolar disorder CHAPTER 2 Prophylaxis of unipolar depression Lithium is significantly superior to antidepressants in preventing relapses that require hospitalisation, with a relative risk of 0.34.27 Lithium prophylaxis is indicated in unipolar d...

Formulations

Adverse effects

Lithium toxicity 282 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2 Formulations There is no clinically significant difference in the pharmacokinetics of the two most widely prescribed brands of lithium in the UK: Priadel and Camcolit. In other c...

Pre-treatment tests

On-treatment monitoring12,58

Discontinuation Bipolar disorder CHAPTER 2 Above 2mmol/L, increased disorientation and seizures usually occur, which can progress to coma and ultimately death. In the presence of more severe symptoms, osmotic or forced alkaline diuresis should be used in a med...

Interactions with other drugs70–72 284 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2 In contrast with these recommendations, a naturalistic study found that, in patients who had been in remission for at least 2 years and had discontinued lithium...

References 286 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2 fenbufen, fenoprofen, flurbiprofen, ibuprofen, indometacin, ketoprofen, lumiracoxib, mefenamic acid, meloxicam, nabumetone, naproxen, piroxicam, sulindac, tenoxicam and tiaprofenic aci...

Valproate

Mechanism of action1

Formulations

Indications Bipolar disorder CHAPTER 2 Valproate Mechanism of action1 Valproate is a simple branched-­chain fatty acid. Its mechanism of action is complex and not fully understood. Valproate inhibits the catabolism of gamma-­aminobutyric acid (GABA), reduces t...

Plasma levels 290 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 2 less effective but better tolerated than lithium.15 Overall, data relating to efficacy in mania are less convincing for valproate than for lithium and a range of antipsychotics.16,1...

Adverse effects

Pre-treatment tests

On-treatment monitoring

Discontinuation Bipolar disorder CHAPTER 2 Adverse effects Valproate can cause both gastric irritation and hyperammonaemia,41 both of which can lead to nausea. Lethargy and confusion can occasionally occur with starting doses above 750mg/day. Weight gain can b...