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Medicines > classes : Dissociative or Research material or [[:Category:Antimanic medicines|Antimanic]]

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generic:
brand:
None (137) · (none, never marketed) (1) · DXM (1) · DXO (1) · Lithobid (extended-release); Eskalith (discontinued in US); Carbolith (Canada); Priadel (UK); Camcolit (UK) (1) · O-DSMT (1) · Spravato (1)
classes: (Click arrow to add another value)
mechanism:
5-HT2A agonist (26) · Monoamine releasing agent (9) · GABAA positive allosteric modulator (8) · CB1/CB2 agonist (7) · Dopamine/norepinephrine reuptake inhibitor (5) · Potent 5-HT2A agonist (5) · LSD analogue; 5-HT2A agonist (4) · Prodrug of LSD; 5-HT2A agonist (4) · NMDA antagonist (3) · Serotonin/norepinephrine/dopamine releasing agent (3) · None (2) · Cathinone analogue; monoamine reuptake inhibitor (2) · Dopamine and norepinephrine reuptake inhibitor (2) · NMDA antagonist; sigma receptor agonist (2) · Prodrug of GHB (2)
uses:
None (141) · No approved medical problem. Encountered as a designer/research benzodiazepine and, increasingly, as an adulterant in illicit opioid supplies. (1) · Treatment-resistant depression (TRD) in adults, as adjunct to oral antidepressant (FDA-approved March 2019). Depressive symptoms in adults with MDD with acute suicidal ideation or behavior (FDA-approved Aug 2020). (1)
starting dose:
None (141) · Induction (TRD): 56 mg intranasal twice weekly × 4 weeks. Maintenance: 56-84 mg once weekly × 4 weeks, then 56-84 mg every 1-2 weeks. For acute suicidality: 84 mg twice weekly × 4 weeks. Administered under medical supervision in REMS-certified site. (1) · No medical dose. Active recreational doses reported in the 0.5–1.5 mg range (similar potency to alprazolam). (1)
preparations:
None (140) · 28 mg/device (each dose uses 2 devices) (1) · Illicit tablets ("bars"), powders, blotter, occasionally solutions. No pharmaceutical product exists. (1) · Lithium carbonate: immediate-release capsules (150 mg, 300 mg, 600 mg) and tablets (300 mg); extended-release tablets (300 mg, 450 mg). Lithium citrate: oral solution (8 mEq/5 mL, equivalent to 300 mg lithium carbonate per 5 mL) for patients unable to swallow tablets. (1)
fda max:
None (140) · 84 mg per session (1) · N/A (never approved) (1) · No defined absolute maximum; dosing is guided by serum level monitoring. Levels above 1.5 mEq/L carry increasing toxicity risk. Levels consistently above 1.2 mEq/L are generally not maintained in clinical practice.'"`UNIQ--ref-00000052-QINU`"' (1)
routes:
None (140) · Intranasal (under direct medical supervision) (1) · intranasal; rectal and IV reported. (1) · Oral (2) · sublingual (1)
onset:
None (140) · Antimanic effects begin within 5-7 days of reaching therapeutic serum levels, with full response often requiring 2-3 weeks. For acute mania, a neuroleptic is typically added for rapid sedation while lithium takes effect.'"`UNIQ--ref-00000053-QINU`"' (1) · Within hours of first administration (1) · ~20–40 min PO; faster sublingual/intranasal. (1)
duration:
None (141) · 6–10 h subjective; full pharmacologic effect considerably longer. (1) · Acute effect ~24 hours; cumulative effect builds with repeated dosing (1)
halflife:
None (140) · Approximately 18-24 hours after acute administration; may extend to 36-48 hours with chronic dosing as tissue compartments equilibrate. Serum trough levels should be drawn 12 hours after the last dose for accurate interpretation.'"`UNIQ--ref-00000055-QINU`"' (1) · Estimated ~12–17 h (some sources cite up to ~21 h); active metabolites prolong effect. (1) · ~7-12 hours (1)
bioavailability:
None (141) · Not formally characterized in humans. (1) · ~48% intranasal (1)
pregnancy:
None (141) · Avoid. Benzodiazepines are associated with neonatal sedation, floppy-infant syndrome, and withdrawal; teratogenic signal weak but non-zero. Designer benzo with no safety data, assume worst-case. (1) · Avoid; may cause fetal harm (1)
legal:
None (141) · Not a controlled substance in the United States, European Union, United Kingdom, Canada, or Australia. Prescription-only in all of these jurisdictions due to the narrow therapeutic index and the need for serum monitoring. No abuse potential has been identified. (1) · Rx, Schedule III (US). REMS program required. (1)

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