Bipolar Medications in Children and Adolescents: Mood Stabilizers - Mood Stabilizers in Children and Adolescents
Page 3 of 3
Drug Name | Carbamazepine (Tegretol) -- Effective in patients who have not responded to lithium therapy. Also can act to inhibit seizures induced through the kindling effect, which is thought to occur by way of repeated limbic stimulation. Has been effective in treating patients who have rapid-cycling bipolar disorder or those who have not been responsive to lithium therapy. |
| Adult Dose | 200 mg PO bid (100 mg PO qid if susp) May increase at weekly intervals by no more than 200 mg/d tid/qid (bid with ER) until best response obtained; not to exceed 1600 mg/d |
| Pediatric Dose | 10-20 mg/kg/d PO divided bid (qid with susp) |
| Contraindications | Documented hypersensitivity; history of bone marrow depression; administration of MAOIs within last 14 d |
| Interactions | Serum levels may increase significantly within 30 d of danazol coadministration (avoid whenever possible); do not administer concurrently with MAOIs; cimetidine may increase toxicity, especially if taken in first 4 wk of therapy; carbamazepine may decrease primidone and phenobarbital levels (their coadministration may increase carbamazepine levels) |
| Pregnancy | D - Unsafe in pregnancy |
| Precautions | Caution with increased intraocular pressure; obtain CBCs and serum-iron baseline prior to treatment, during first 2 mo, and yearly or every other year thereafter; can cause drowsiness, dizziness, and blurred vision; caution while driving or performing other tasks requiring alertness |
Drug Name | Risperidone (Risperdal) -- Binds dopamine D2-receptor with 20 times lower affinity than for 5-HT2-receptor. Indicated for short-term (3-wk) treatment of acute mania associated with bipolar disorder. May use alone or combined with lithium or valproate. |
| Adult Dose | 2-3 mg PO qd up to 3 wk; may increase by 1 mg/d at 24-h intervals, not to exceed 6 mg/d |
| Pediatric Dose | Data limited; 0.25 mg PO bid or 0.5 mg qhs initially; titrate as tolerated to target dosage of 2-4 mg/d; not to exceed 6 mg/d |
| Contraindications | Documented hypersensitivity |
| Interactions | Coadministration with carbamazepine may decrease effects; may inhibit effects of levodopa; clozapine may increase levels; PO solution not compatible with cola or tea |
| Pregnancy | C - Safety for use during pregnancy has not been established. |
| Precautions | May cause extrapyramidal reactions, hypotension, tachycardia, and arrhythmias; hyperglycemia (some cases extreme) may occur, resulting in ketoacidosis, hyperosmolar coma, or death; do not split or chew PO disintegrating tablets |
Drug Name | Quetiapine (Seroquel) -- May act by antagonizing dopamine and serotonin effects. Newer antipsychotic used for long-term management. Improvements over earlier antipsychotics include fewer anticholinergic effects and less dystonia, parkinsonism, and tardive dyskinesia. |
| Adult Dose | Initial: 25 mg PO bid/tid; increase by 25-50 mg bid/tid on day 2 or 3 to achieve range 300-400 mg divided bid/tid by day 4; adjust as needed at intervals of >2 d with adjustments of 25-50 mg bid Maintenance: 150-750 mg/d PO; not to exceed 800 mg/d |
| Pediatric Dose | Data limited; 50 mg PO bid initially; titrate as tolerated to target dosage of 400-600 mg/d |
| Contraindications | Documented hypersensitivity |
| Interactions | May antagonize levodopa and dopamine agonists; phenytoin, thioridazine, and other liver enzyme inducers may reduce levels; cytochrome P450 (CYP) 3A inhibitors (eg, ketoconazole, fluconazole, erythromycin) increase serum concentration |
| Pregnancy | C - Safety for use during pregnancy has not been established. |
| Precautions | May induce orthostatic hypotension associated with dizziness, tachycardia, and syncope; has been associated with NMS and tardive dyskinesia; hyperglycemia (some cases extreme) may occur, resulting in ketoacidosis, hyperosmolar coma, or death; caution in hepatic impairment (decrease dose) |
Drug Name | Olanzapine (Zyprexa) -- Mechanism of action for acute manic episodes associated with bipolar I disorder unknown. Available as tab, PO disintegrating tab (Zyprexa, Zydis), and IM dosage forms. |
| Adult Dose | 10-15 mg PO qd; adjust by 5 mg/d at intervals >24 h; not to exceed 20 mg/d Agitation associated with bipolar mania: 10 mg IM once; may repeat after 2 h; not to exceed 30 mg/24 h Geriatric or debilitated individuals: 2.5-5 mg IM/dose |
| Pediatric Dose | Data limited; 2.5-5 mg PO qhs initially; titrate as tolerated to target dosage of 10-20 mg/d |
| Contraindications | Documented hypersensitivity |
| Interactions | Fluvoxamine may increase effects; antihypertensives may increase risk of hypotension and orthostatic hypotension; levodopa, pergolide, bromocriptine, charcoal, carbamazepine, omeprazole, rifampin, and cigarette smoking may decrease effects |
| Pregnancy | C - Safety for use during pregnancy has not been established. |
| Precautions | Caution in narrow-angle glaucoma, cardiovascular disease, cerebrovascular disease, prostatic hypertrophy, seizure disorders, hypovolemia, and dehydration; hyperglycemia (some cases extreme) may occur, resulting in ketoacidosis, hyperosmolar coma, or death; administration of >1 IM injection associated with substantial orthostatic hypotension (33%), maintain patient in recumbent position and monitor blood pressure before repeating IM doses |
Sources:
- Kowatch RA, Bucci JP. Mood stabilizers and anticonvulsants. Pediatr Clin North Am. Oct 1998;45(5):1173-86, ix-x.
- Kowatch RA, Fristad M, Birmaher B, et al. Treatment guidelines for children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry. Mar 2005;44(3):213-35.
- Medication information listed in tables is from package inserts for each medication.
next: Childhood Bipolar and Special Education Needs
~ bipolar disorder library
~ all bipolar disorder articles
reviewed by:
Harry Croft, MD (Psychiatrist)
Medical Director, HealthyPlace.com
Created on December 20, 2008 Last Updated on November 29, 2011
In Bipolar Disorder
Who's Online
We have 2588 guests and 2 members online
