Drugs are used in mania to control acute attacks and to prevent their recurrence.
Benzodiazepines: Use of benzodiazepines may be helpful in the initial stages of treatment until lithium achieves its full effect; they should not be used for long periods because of the risk of dependence.
In an acute attack of mania, treatment with an antipsychotic drug is usually required because it may take a few days for lithium to exert its antimanic effect.
Carbamazepine may be used for the prophylaxis of bipolar disorder (manic-depressive disorder) in patients unresponsive to lithium; it seems to be particularly effective in patients with rapid-cycling manic-depressive illness (4 or more affective episodes per year).
Valproic acid is licensed for the treatment of manic episodes associated with bipolar disorder. It may be useful in patients unresponsive to lithium.
Indications: Bipolar Disorder, Bipolar Disorder in Remission, Manic Bipolar Disorder.
Contraindications: Lactating Mother, Lithium Toxicity, Pregnancy, Chronic Heart Failure, Conduction Disorder of the Heart, Diabetes Insipidus, Hyponatremia, Renal Disease, Severe Dehydration, Severe Infection.
Dose and Administration: For lithium carbonate adult and child over 12 years, treatment, initially 1–1.5 g daily; prophylaxis, initially 300–400 mg daily. For lithium sulphate, Treatment and prophylaxis, initially 1.04–3.12 g daily in 2 divided doses (elderly or patients less than 50 kg, 520 mg twice daily).
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