Selected Medications for Bipolar Disorder and Schizophrenia*†

Selected Medications for Bipolar Disorder and Schizophrenia*†
Medication	Indication	CYP Substrates	Comments
LithiumLithium
Lithium extended-release in childrenLithium extended-release in children ≥ 12 years‡	Acute mania and maintenance	—	Dose titrated to a blood level of 0.8–1.2 mEq/L (or mmol/L) Associated with decreased suicidality, decreased depression, and better psychosocial functioning in children with bipolar disorder Monitor kidney function, thyroid function, serum calcium levels
Lithium, immediate-release in childrenLithium, immediate-release in children ≥ 7 years‡,§	Acute mania and maintenance	—	Dose titrated to a blood level of 0.8–1.2 mEq/L (or mmol/L) Maximum daily dose is 40 mg/kg Associated with decreased suicidality, decreased depression, and better psychosocial functioning in children with bipolar disorder Monitor kidney function, thyroid function, serum calcium levels
Antipsychotics
Aripiprazole in children (for bipolar IAripiprazole in children (for bipolar I≥ 10 years; for schizophrenia, ≥ 13 years)‡	Bipolar Schizophrenia	2D6, 3A4	The only antipsychotic that does not increase prolactin level
Asenapine in children Asenapine in children≥10 years	Bipolar I	1A2	Sublingual administration allows rapid entry into systemic circulation Sedation and somnolence, transient tongue numbness and tingling
Lurasidone in children (for bipolar I Lurasidone in children (for bipolar I≥ 10 years; for schizophrenia ≥ 13 years)	Bipolar I Schizophrenia	3A4	Greater improvement in bipolar I depression with elevated CRP in adults and ages 10-17 years¶
Olanzapine in childrenOlanzapine in children≥13 years‡	Bipolar I Schizophrenia	IA2, 2D6, 3A4	Causes weight gain, which may limit use in some patients Can increase liver transaminases
Olanzapine/fluoxetine fixed combination in children Olanzapine/fluoxetine fixed combination in children> 10 years‡,§	Bipolar I	IA2, 2D6, 3A4	Limited experience in children
Paliperidone in children Paliperidone in children≥12 years ‡,§	Schizophrenia	Cleared unchanged through kidneys 2D6, 3A4	Closely related to risperidoneClosely related to risperidone Very limited experience in children
Quetiapine, immediate-release, in children (for bipolar I Quetiapine, immediate-release, in children (for bipolar I≥ 10 years; for schizophrenia ≥ 13 years)‡	Bipolar Schizophrenia	3A4	Causes sedation that may limit dose increases
Risperidone in children (for bipolar I Risperidone in children (for bipolar I≥ 10 years; for schizophrenia ≥ 13 years) ‡	Bipolar Schizophrenia	2D6	Associated with risk of irreversible gynecomastia Maintenance dose highly variable Doses up to 6 mg/day have been studied, but they provide no additional benefit and increase risk of neurologic adverse effects
Ziprasidone in children Ziprasidone in children≥10 years‡	Acute mania Psychosis	—	Very limited experience in children QTc interval prolongation
Antiseizure medications
CarbamazepineCarbamazepine	Bipolar	—	Metabolic enzyme induction, possibly requiring dose adjustments May cause Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) especially in patients with HLA-B15:02* genotype (more common in East Asian populations) and maculopapular exanthema (MPE), drug reaction with eosinophilia (DRESS) and SJS/TEN in patients with HLA-A31:01* genotype (more common in European and Hispanic populations)
Divalproex	Bipolar I	—	Dose titrated to a blood level of 50–125 mcg/mL Avoid in people in the reproductive age group
LamotrigineLamotrigine	Bipolar	—	Requires that dosing guidelines in the package insert be followed closely
* These medications pose a small but serious risk for a wide variety of major adverse effects. Therefore, benefits must be carefully weighed against potential risks.
† This table is not a substitute for the full prescribing information.
‡ These medications increase the risk of weight gain, negative effects on the lipid profile, increases in glucose and prolactin levels, and QT prolongation.
§ These medications have not been studied in children.
¶ Bipolar I disorder is one presentation of bipolar disorder and is characterized always by mania, that may sometimes also be accompanied by depression. CRP = C-reactive protein; CYP = cytochrome P450.

* These medications pose a small but serious risk for a wide variety of major adverse effects. Therefore, benefits must be carefully weighed against potential risks.

† This table is not a substitute for the full prescribing information.

‡ These medications increase the risk of weight gain, negative effects on the lipid profile, increases in glucose and prolactin levels, and QT prolongation.

§ These medications have not been studied in children.

¶ Bipolar I disorder is one presentation of bipolar disorder and is characterized always by mania, that may sometimes also be accompanied by depression.

CRP = C-reactive protein; CYP = cytochrome P450.

In these topics