Clozapine (Clozaril)

Clozaril is a unique antipsychotic mood stabilizer, highly effective in many cases when no other medication has been. Not only the mood changes improve on it, it often improves thinking, impulse control and decision-making. It often prevents repeated admissions or need for long-term placements.

Many psychiatrists however are unfamiliar with and avoid it. This is because on very rare cases, it can cause serious side effect of agranulocytosis (drop in the infection fighting white blood cells).

We, however, have been able to reduce this risk significantly by using a very careful process as noted bellow:

• Blood tests (CBC) are done prior to start of Clozaril and weekly thereafter, to ensure that WBCs are normal. The pharmacy will not dispense the medication without these results. These tests can be reduced to every 2 weeks, if the blood counts have been normal for 6 months and to once a month after a year.
• The usual therapeutic dose is 200-300 mg/ day, but it will start at the very small dose of 12.5 mg /day. The dosage then is increased at increments of 25-50 mg, at frequency of no shorter than 3 days. I do it more cautiously and at 25 mg increments.
• If for some reason your child skips taking it for a week or more, it should be resumed at a small dose once again.
• Not all pharmacies are set up to dispense it. Be sure to ask your pharmacy prior to the discharge, if they dispense Clozaril.

Agranulocytosis and other potential side effects:

• Report signs of any infection (such as fever) to your doctor. Almost these symptoms are due the common illnesses that everyone gets (cold and flu). To be on the safe side, however, I recommend an examination and/or blood tests, even if it seems to be a common cold.
• Constipation is a frequent side effect. While constipation for a short period of time is not serious, a very prolonged period can be. Please monitor that your child is having regular bowel movements.
• Cardiac problems are very rare. Any unexplainable tiredness or shortness of breath should be reported to your doctors immediately. Your child should have routine EKGs and comprehensive blood test once or twice per year.
• Lithium is a mood stabilizing medication for treatment of bipolar disorders. It however can also counteract the lowering of the white blood cells cause by Clozaril (though this has not been proven with studies). I use it in some patients for this purpose. Make sure that your doctor knows the reason for it and not stop it, thinking that it is an unnecessary mood stabilizer.

These are only a partial list of potential side effects. You should discuss any concerns or questions with your physician.

Lithium

Lithium (Lithobid, Eskalith, Lithonate, Lithotabs)

IMPORTANT NOTE: This is a summary and does not contain all possible facts. For complete information about these product ask your health care professional. This information is also for use in children. Adult patients may have medical conditions or be taking medications that will require additional precautions.

General information

Psychiatric medications are used to treat certain brain conditions (such as mood conditions, thought disorders like schizophrenia, or ADHD). They work by helping to restore the balance of certain natural chemicals in the brain.

The dosage is based on your medical condition and response to therapy. Take these medications as directed, even if you are feeling better and thinking more clearly. Do not make any changes without consulting with your doctor.

You should familiarize yourself with the side effects but do not allow them to scare you. In most cases they are mild & temporary. The serious side effects are very rare. Remember that the benefit of treating your child’s medical condition is far greater than the risk of side effects or leaving it untreated.

Minor or moderate side effects usually go away by themselves or by reducing the dosage. You should however stop taking the medication if you notice serious side effects and report them to your doctor right away.

Lithium is used to treat mood disorders (Bipolar conditions).

WARNING:

Lithium is very safe in most people when you have the right amount of lithium in your body. Too much of it however, can be toxic & cause serious medical problems such as seizures, requiring immediate hospitalization. The difference between the correct amount of lithium and too much, is small. Therefore, it is important that your blood level be checked regularly.

Fortunately, lithium’s blood level remains stable almost always if you do not take extra dose, don’t get dehydrated, do not have a kidney problem, and are not on a low salt diet.

Also before it reaches a toxic level, it gives you warning signs such as nausea, diarrhea, shaking of the hands, slurred speech and wobbly gate. You should stop it right away and call your doctor if you have any of these symptoms.

HOW TO USE:
Take with food or milk or immediately after meals to prevent stomach upset. Drink 8-12 glasses of water or other fluid each day and maintain a regular diet while taking this medication. Do not change the amount of salt in your diet.

SIDE EFFECTS:
Mild or temporary side effects: tiredness, increased thirst, increased frequency of urination, and mild trembling of the hands.

Weight gain or severe tiredness or tremor, and skin rash may need discontinuation of the medicine.

In some patients, lithium slows down thyroid gland. Again your doctor should order thyroid studies at the start of lithium and then periodically. If hypothyroidism occurs, lithium should be discontinued. In select cases, when lithium is the only medication that is effective for your mood disorder, the doctor may decide to continue it but supplement your thyroid hormone with prescribed hormone such as Synthroid.

OVERDOSE:
If the child accidentally overdoses, go to your emergency room immediately. If he has taken only 1 or 2 extra dose, he probably will be ok, but call your doctor right away to be sure.

Depakote

Depakote

IMPORTANT NOTE: This is a summary and does not contain all possible facts. For complete information about these product ask your health care professional. This information is also for use in children. Adult patients may have medical conditions or be taking medications that will require additional precautions.

General information

Psychiatric medications are used to treat certain brain conditions (such as mood conditions, thought disorders like schizophrenia, or ADHD). They work by helping to restore the balance of certain natural chemicals in the brain.

Many medications have more than one indication. For example, medications such as Depakote, Tegretol, Trileptal, Neurontin , Topamax , and Lamictal are also used to treat seizures and migraine.

The dosage is based on your medical condition and response to therapy. Take these medications as directed, even if you are feeling better and thinking more clearly. Do not make any changes without consulting with your doctor.

You should familiarize yourself with the side effects but do not allow them to scare you. In most cases they are mild & temporary. The serious side effects are very rare. Remember that the benefit of treating your child’s medical condition is far greater than the risk of side effects or leaving it untreated.

Minor or moderate side effects usually go away by themselves or by reducing the dosage. You should however stop taking the medication if you notice serious side effects and report them to your doctor right away.

Like any other medication, you may be allergic to these & develop rashes & hives and should stop it in consultation with your doctor.

Mood stabilizing medications can cause serious medical conditions on rare occasions. It is therefore a good idea to have some blood tests once a year preventatively.

Tests for drug levels, liver functions and blood counts, are needed with medications such as Depakote or Tegretol.

SIDE EFFECTS:

· Diarrhea, dizziness, drowsiness, hair loss, blurred/double vision, shakiness (tremor), weight increase.

· Unlikely side effects: fast/irregular heartbeat, swelling of hands/feet, uncontrolled eye movement (nystagmus).

· unlikely but serious side effects include a drop in platelets (small blood “cells” that help stop bleeding) which can cause unexplained bruising or bleeding.

· Rare cases of liver or pancreas damage have been reported. They can show itself by unusual tiredness, swelling of the face, dark urine, persistent nausea/vomiting, severe stomach/abdominal pain, yellowing eyes or skin. Tell your doctor immediately or visit an emergency room if you develop these or any other unexpected & severe condition.

DRUG INTERACTIONS:
This medication, like many others , is processed in the liver. They can increase or decrease liver enzymes & can therefore affect each others’ levels in the blood (increasing it & causing toxicity or decreasing the levels & effectiveness of the other drug). You should therefore tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use.

MISSED DOSE:
If you miss a dose, take it as soon as you remember. If is near the time of the next dose, skip the missed dose and resume your usual dosing schedule.