Adele Viguera, MD, MPH, Assistant Professor of Psychiatry, Director of Clinical Research, Center for Women’s Mental Health, Cleveland Clinic, discusses how to maintain therapeutic drug levels for bipolar disorder in pregnant patients who are usually taking more than one medication. Overall, dosage should be adjusted according to patient symptoms rather than drug levels.

Summary:
Lithium doses are generally kept the same during pregnancy; lamotrigine clearance levels increase during pregnancy so dosage may need to be adjusted; valproic acid dosage does not need to be adjusted.

References and Resources
Howland RH. Prescribing psychotropic medications during pregnancy and lactation: principles and guidelines. J Psychosoc Nurs Ment Health Serv. 2009 May;47(5):19-23. Review.
Nguyen HT, Sharma V, McIntyre RS. Teratogenesis associated with antibipolar agents. Adv Ther. 2009 Mar;26(3):281-94. Epub 2009 Mar 28.

Related videos on The Doctor’s Channel:
Lamotrigine and valproic acid in pregnancy
Lithium in pregnancy
Bipolar disorder and pregnancy

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