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Medicines (732)

Medicines > classes

: Dissociative

or Sedative-Hypnotic

or [[:Category:Mood stabilizers|Mood stabilizer]]

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None (26) · (none, never marketed) (1) · Abilify (oral), Abilify Maintena (monthly IM LAI), Aristada (aripiprazole lauroxil IM LAI), Abilify Asimtufii (bi-monthly IM LAI), Abilify MyCite (digital ingestion sensor) (1) · Dalmane (1) · Doral (1) · Doriden (1) · DXM (1) · DXO (1) · Halcion (1) · Hetlioz (1) · Imovane (1) · Lamictal (IR), Lamictal XR, Lamictal ODT (1) · Lithobid (lithium carbonate extended-release, 300 mg and 450 mg tablets); Lithium carbonate immediate-release tablets and capsules (150/300/600 mg; multiple generics); Lithium citrate oral solution (8 mEq/5 mL, approximately equivalent to 300 mg lithium carbonate per 5 mL). (1) · Lunesta (1) · Mogadon (1) · Nembutal (1) · Placidyl (1) · ProSom (1) · Quaalude (1) · Restoril (1) · Risperdal (oral), Risperdal M-Tab (ODT), Risperdal Consta (biweekly IM LAI), Perseris (monthly SC LAI), Uzedy (monthly/bimonthly SC LAI), Rykindo (biweekly IM LAI) (1) · Rohypnol (1) · Rozerem (1) · Seconal (1) · Sonata (1) · Spravato (1) · Tegretol (IR, XR, suspension), Carbatrol (ER), Equetro (ER for bipolar), Epitol (1) · THIP (1) · Versed (1) · Xyrem (1) · Zyprexa (oral, IM acute), Zyprexa Zydis (ODT), Zyprexa Relprevv (LAI), Lybalvi (with samidorphan) (1)

None (49) · Acute mania: 300 mg PO TID (immediate-release) or 900 mg PO once daily (extended-release Lithobid); titrate based on serum levels to target 0.8-1.2 mEq/L. Maintenance: target 0.6-0.8 mEq/L. All dosing guided by serum lithium levels drawn at the 12-hour post-dose standardized trough. (1) · 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) · Schizophrenia / acute mania: 5-10 mg PO once daily, target 10-15 mg/day. Acute agitation IM: 10 mg, may repeat in 2 hours. Relprevv LAI: 150-300 mg every 4 weeks after oral overlap (1) · Schizophrenia / mania: 1 mg PO BID, titrate to 4-8 mg/day. Pediatric autism irritability: 0.25-0.5 mg/day, weight-titrated. Consta LAI: 25 mg IM every 2 weeks after oral overlap (1) · Schizophrenia/bipolar mania: 10-15 mg PO once daily, target 15-30 mg. MDD adjunct: 2-5 mg/day, target 5-15 mg. Pediatric autism irritability: 2 mg, titrate to 5-15 mg. Maintena LAI: 400 mg IM every 4 weeks after oral overlap (1) · Seizures: 200 mg PO BID, titrate by 200 mg/week to 800-1200 mg/day. Trigeminal neuralgia: 100-200 mg BID, titrate to 200-400 mg TID. Bipolar: 200 mg BID, titrate to 1600 mg/day (1)

None (49) · 28 mg/device (each dose uses 2 devices) (1) · Illicit tablets ("bars"), powders, blotter, occasionally solutions. No pharmaceutical product exists. (1) · IR tablets 200 mg; chewable 100 mg; oral suspension 100 mg/5 mL; XR tablets 100, 200, 400 mg (Tegretol XR); ER capsules 100, 200, 300 mg (Carbatrol, Equetro) (1) · IR tablets 25, 100, 150, 200 mg; chewable dispersible tablets 2, 5, 25 mg; ODT 25, 50, 100, 200 mg; XR tablets 25, 50, 100, 200, 250, 300 mg (1) · Tablets 0.25, 0.5, 1, 2, 3, 4 mg; M-Tab ODT 0.5, 1, 2, 3, 4 mg; oral solution 1 mg/mL; Consta LAI 12.5, 25, 37.5, 50 mg; Perseris SC LAI 90, 120 mg monthly (1) · Tablets 2, 5, 10, 15, 20, 30 mg; ODT 10, 15 mg; oral solution 1 mg/mL; acute IM injection 9.75 mg/1.3 mL; Maintena LAI 300, 400 mg monthly; Aristada LAI 441, 662, 882, 1064 mg (4-8 week dosing); Asimtufii bi-monthly (1) · Tablets 2.5, 5, 7.5, 10, 15, 20 mg; ODT (Zydis) 5, 10, 15, 20 mg; acute IM injection 10 mg/vial; Relprevv LAI 210, 300, 405 mg vials (1)

None (49) · 1200 mg/day (adult seizures); 1600 mg/day (bipolar mania) (1) · 16 mg/day (schizophrenia, adult); 6 mg/day (bipolar maintenance, autism irritability) (1) · 20 mg/day (oral) (1) · 30 mg/day (adult schizophrenia); 15 mg/day (MDD adjunct) (1) · 400 mg/day (bipolar monotherapy); 700 mg/day (epilepsy with enzyme-inducing comedication) (1) · 84 mg per session (1) · N/A (never approved) (1)

None (48) · intramuscular (acute and long-acting) (2) · intramuscular (LAI) (1) · Intranasal (under direct medical supervision) (1) · intranasal; rectal and IV reported. (1) · Oral (6) · Oral only. No parenteral lithium formulation exists for clinical use. (1) · subcutaneous (LAI) (1) · sublingual (1)

None (48) · Anticonvulsant effect within days; trigeminal neuralgia relief 24-72 hours; mood-stabilizing effect over weeks (1) · Antiepileptic effect within days at therapeutic level; mood-stabilizing effect emerges over weeks (1) · Neuroleptic effect emerges over days to weeks (1) · Neuroleptic effect emerges over days to weeks; activation symptoms (akathisia, insomnia) often within days (1) · Oral peak plasma 1-2 hours (immediate-release); 4-6 hours (extended-release). Therapeutic antimanic effect typically evident within 5-14 days of achieving target serum levels; for acute mania, a neuroleptic or benzodiazepine is usually co-administered while lithium titration proceeds. (1) · Sedation from first dose; neuroleptic effect emerges over days to weeks (1) · Within hours of first administration (1) · ~20–40 min PO; faster sublingual/intranasal. (1)

None (48) · 24 hours (often divided BID at higher doses) (1) · 24 hours (oral); 2-4 weeks (LAI formulations) (1) · 24 hours (oral); 2-4 weeks (LAI) (1) · 24 hours (oral); 4-8 weeks (LAI) (1) · 6–10 h subjective; full pharmacologic effect considerably longer. (1) · Acute effect ~24 hours; cumulative effect builds with repeated dosing (1) · BID-QID dosing (IR); BID for ER formulations (1) · Lithium's mood-stabilizing benefit is prophylactic and requires continuous maintenance dosing; it is not a PRN or acute-episode-only medicine. Discontinuation is associated with high relapse rates and a potentially rebound worsening of episode frequency. (1)

None (48) · '''Autoinduction''': 25-65 hours initially, falling to 12-17 hours after 2-3 weeks of dosing as carbamazepine induces its own CYP3A4 metabolism. Major clinical implication: doses require re-titration after the autoinduction period'"`UNIQ--ref-0000001D-QINU`"' (1) · 18-36 hours at steady state; longer in elderly patients (24-60 hours) and those with renal impairment. Half-life is entirely a function of glomerular filtration rate, as lithium is exclusively renally eliminated with no hepatic metabolism.'"`UNIQ--ref-0000004C-QINU`"' (1) · 21-54 hours'"`UNIQ--ref-00000026-QINU`"' (1) · Estimated ~12–17 h (some sources cite up to ~21 h); active metabolites prolong effect. (1) · Risperidone 3-20 hours; '''9-hydroxy-risperidone (paliperidone) ~20-24 hours''' is the major active metabolite and is separately marketed as a parent compound (Invega)'"`UNIQ--ref-00000021-QINU`"' (1) · ~25-33 hours alone; ~15 hours with enzyme inducers; '''≥60 hours with valproate''' (UGT inhibition)'"`UNIQ--ref-00000025-QINU`"' (1) · ~7-12 hours (1) · ~75 hours (long, accumulates over weeks)'"`UNIQ--ref-00000023-QINU`"' (1)

None (49) · Not formally characterized in humans. (1) · ~48% intranasal (1) · ~60% (oral); ~100% (IM)'"`UNIQ--ref-00000027-QINU`"' (1) · ~70% (oral)'"`UNIQ--ref-00000022-QINU`"' (1) · ~80% (oral)'"`UNIQ--ref-0000001E-QINU`"' (1) · ~87% (oral)'"`UNIQ--ref-00000024-QINU`"' (1) · ~98% (oral)'"`UNIQ--ref-00000026-QINU`"' (1)

None (49) · '''Among the safest mood stabilizers in pregnancy''' with reassuring monotherapy registry data, in sharp contrast to valproate. Estrogen-containing contraceptives accelerate lamotrigine metabolism, requiring dose adjustments at start and stop of contraception'"`UNIQ--ref-00000027-QINU`"' (1) · '''Substantial teratogenic risk''' including neural tube defects, craniofacial malformations, cardiac defects, and growth restriction; folic acid supplementation and effective contraception are required in reproductive-age patients'"`UNIQ--ref-0000001F-QINU`"' (1) · 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) · Limited human data; signal for neonatal extrapyramidal symptoms and withdrawal with third-trimester exposure.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Signal for gestational diabetes and metabolic syndrome with maternal exposure; the metabolic load can be substantial during pregnancy.[[[Pharmacopedia:Citation needed|citation needed]]] (1) · Signal for neonatal extrapyramidal symptoms and withdrawal with third-trimester exposure.[[[Pharmacopedia:Citation needed|citation needed]]] (1)

None (51) · Rx, Schedule III (US). REMS program required. (1) · [[USLegal:Prescription only|Rx-only]] in US (1) · [[USLegal:Prescription only|Rx-only]] in US. Carries the atypical-neuroleptic '''Boxed Warning''' for increased mortality in elderly patients with dementia-related psychosis'"`UNIQ--ref-00000023-QINU`"' (1) · [[USLegal:Prescription only|Rx-only]] in US. Carries the FDA '''Boxed Warning for serious skin reactions''' including Stevens-Johnson syndrome and toxic epidermal necrolysis, with the risk concentrated in the first 2-8 weeks of therapy and elevated by rapid titration'"`UNIQ--ref-00000028-QINU`"' (1) · [[USLegal:Prescription only|Rx-only]]. Not scheduled; no abuse potential. One of the oldest continually-used psychotropic medicines, with FDA approval dating to 1970. (1)