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Excerpt from  Cafer's Mood Stabilizers and Antiepileptic Drugs Topiramate (TOPAMAX)  toh PEER a mate / TOH pah max “Top at max (speed on) Top (of) pyramid” ❖  Antiepileptic   ❖ Voltage-gated sodium and calcium channel blocker    ❖ Glutamate ⇩ FDA approved for:   ❖  Focal seizures   ❖ Bilateral tonic-clonic seizures   ❖ Lenno x-Gastaut syndrome  ❖ Migraine prophylaxis  ❖ Obesity, long-term tx  (in combination with phentermine) Used off label for: ❖ Alcoholism (relapse prevention)  ❖ Bipolar disorder (adjunct)  ❖ Weight loss (monotherapy)  ❖ Binge eating disorder  ❖ PTSD Nightmares Topiramate is prescribed by psychiatrists for several off-label uses. The most compelling data is for preventing alcohol relapse . Although not FDA-approved for alcoholism, it is recommended in the 2015 US Veterans Affairs guidelines for moderate/severe alcohol use disorder.  Nicknamed ...

Excerpt from  Cafer's Mood Stabilizers and Antiepileptics Lithium Pharmacokinetic Interactions Lithium is removed from the body almost exclusively by the kidneys. Several medications affect the rate of lithium clearance. Since lithium has a narrow therapeutic index, blood levels need to be closely followed.  Thiazide diuretics and NSAIDS have the greatest potential to increase lithium concentrations, usually 25% to 40%.  Rarely the increase may be much greater, leading to lithium toxicity. If another prescriber insists on adding a thiaze or NSAID, a reasonable approach is to decrease lithium dose by about 30% and recheck blood level in one week.  Educate patients that NSAIDS, blood pressure meds, and diuretics can cause lithium toxicity. For OTC pain medications, they should choose Tylenol or aspirin . Advise them to inform the prescriber if they are planning to change their caffeine intake. Excedrin is OK (combo of aspirin, acetaminophen, and caffeine). Check lithi...

Excerpt from  Cafer's Mood Stabilizers and Antiepileptic Drugs ,  available on Amazon Lithium dosing  Excerpt from Cafer's Psychopharmacology, available soon on Amazon  With lithium treatment (at standard doses), it is necessary to monitor blood levels. As for any drug, blood levels should be checked at “trough”, which is about 12 hours after the last dose. For treatment of acute mania , a relatively high level of 1.0 to 1.4 mmol/L is desired. Once mood has stabilized, the maintenance dose should be decreased to achieve a level of 0.6 to 1.0 mmol/L. . For augmentation of treatment-resistant depression (TRD), the recommended target serum level is 0.5–0.8 mmol/L. A level of 2.0 mmol/L is considered toxic . Discontinuation of lithium is ideally accomplished by slow taper over about 6–12 weeks. It could be argued that there is no such thing as a subtherapeutic lithium level. Some naturopathic doctors recommend tiny dose 5–20 mg (equivalent) lithium orotate capsules as a...