Rx Note

Introduction Bipolar disorder is characterized by recurrent episodes of elevated or irritable mood and depression , accompanied by changes in sleep and energy and associated with cognitive, physical and behavioural symptoms. Bipolar I disorder is characterized by at least 1 episode of mania , and usually episodes of depression and/or hypomania. Bipolar II disorder is characterized by a history of major depressive episodes and hypomanic episodes only, without episodes of mania. Bipolar disorder has a strong genetic basis and a peak onset in young people . Management Consider mood stabilizers (e.g. lithium or valproate) and second-generation antipsychotics (e.g. quetiapine, lurasidone, aripiprazole, olanzapine, risperidone) for the primary treatment of bipolar disorder. For maintenance treatment of bipolar disorder, aim for the highest tolerable lithium plasma level in the range of 0.6-0.8 mmol/L. Reduce to 0.4-0.6 mmol/L in case of good response but poor tolerance, or Increase to 0.8...

Indications Clozapine is an antipsychotic that should be offered to people with schizophrenia whose illness has not responded adequately to treatment despite the sequential use of adequate doses of at least 2 different antipsychotic drugs (i.e. treatment resistant schizophrenia ). Also, it is used to treat psychosis associated with Parkinson's disease . Initiation Schedule Start treatment at a low dose and to increase dosage slowly. Many of the adverse effects of clozapine are dose-dependent and associated with speed of titration. Adverse effects (e.g. sedation, hypersalivation and hypotension) also tend to be more common and severe at the beginning of therapy. Taken at night. Blood pressure should be monitored hourly for 6 hours because of the hypotensive effect of clozapine. This monitoring is not usually necessary if the first dose is given at night. Missed Doses If, for any reason, a patient misses <2 days' clozapine, restart at the dose prescribed before the event. Do ...