Drug classification
- anticonvulsant- mood stabilizer
Dose range
PO: 400 mg daily in divided doses- range generally 400-800 mg
Pharmacological action
- decreases synaptic transmission in CNS by affecting sodium channels in neurons
Therapeutic uses
- bipolar disorder- seizures- tregeminal neuralgia- diabetic neuropathy
Side effects/adverse effects
- suicidal thoughts- ataxia- drowsiness, psychosis, blurred vision- increased liver enzymes- Stevens-Johnson syndrome- toxic epidermal necrolysis- aplastic anemia- agranulocytosis- dizziness, hypotension, sedation- leukopenia, rashes
Medication/food interactions
- corticosteroids (decrease effectiveness)- contraceptives (decrease effectiveness)- benzos and Haldol (decrease effectiveness)- MAOIs (use caution)- SSRIs and antidepressants: may increase levels and cause toxicity- grapefruit juice increases levels
Nursing interventions/client education
- take as directed- no other CNS depressants- use sunscreen- non-hormonal birth control- monitor for skin changes, rashes- assess mental status- notify MD if more than 1 dose missed- report thoughts of suicide, new or worsening depression, anger, aggression- notify MD if pregnant- assist to rise from sitting position- monitor gait- monitor CBC for platelets, iron and WBC- monitor labs for therapeutic range (4-12)
Nursing adminstration (concerns)
- monitor platelets, iron, and WBC- do not use if patient has bone marrow depression- monitor labs for increased BUN, urine protein, glucose, calcium
Evaluation of medication effectiveness
- decreased mania and depressive symptoms in bipolar I disorder- decrease in pain- absence or reduction of seizures