Indications: bipolar disorder (reduces risk of attempted and completed suicide by 80%), mood stabilisation

Contraindications

• CVD/renal disease

• hypothyroidism

• conditions with hyponatraemia

  <aside> 💡 care with ACE-I, NSAIDs, Thiazides, alcohol

  </aside>

MOA : unknown. ? inhibits recycling of neuronal membrane lipids. Renally excreted.

Dosage

• narrow therapeutic range

• effective for mania and plasma level 0.8-1mmol

• gold standard bipolar prophylaxis plasma level 0.6 -0.8mmol/L

• take levels 12hrs post dose, then every 3-6m

  <aside> 💡 don't stop suddenly

  </aside>

Side effects related to plasma level

• Mild GI upset, fine tremor, polyuria, polydipsia, worsening of psoriasis, metallic taste in mouth, ankle oedema, weight gain
• nephrogenic DI
• AKI