Table 3 Recommended Dosage Adjustments for Patients with Comorbid Hepatic and Renal Disease
From: Special considerations in the treatment of patients with bipolar disorder and medical co-morbidities
Drug + | Hepatic Disease | Renal Disease |
|---|---|---|
Lithium * | May need to increase dose with ascites due to fluid shifts | Contraindicated in Acute Renal Failure. HD dosing: 300–600 mg in singe post-HD dose |
Valproate * | Reduce dose with elevated transaminases | None |
Carbamazepine | Reduce dose with elevated transaminases | Reduce dose with symptoms of toxicity due to reduced clearance of toxic metabolite |
Olanzapine * | None | None |
Risperidone * | May need to reduce dose | Reduce dose by 50–60% due to diminished clearance |
Quetiapine * | May need to reduce dose | None |
Ziprasidone | None | Use intramuscular formulation with caution |
Lamotrigine * | May need to reduce dose due to prolonged half-life | May need to reduce dose |
Gabapentin | None | Dose reduction proportional to rise in creatinine |
Topiramate | May need to reduce dose as clearance of drug may be decreased | Reduce dose by half |