Adverse Effects and Possible Monitoring of Mood Stabilizers

MedicationSummary of adverse effectsSuggested monitoring
LithiumReduced renal function, hypothyroidism, nausea, diarrhea, abdominal distress, sedation, tremor, polyuria, wt gain, acne, cardiac conduction problems, hypoparathyroidismBaseline: serum electrolytes, creatinine, BUN, calcium, CBC count, TFTs, EKG, pregnancy test (sexually active female patients)
Wt gain may be additive when combined with an atypical antipsychotic28Ongoing: lithium level, renal function, thyroid function, calcium
Toxic levels may produce confusion, ataxia, dysarthria, seizures, coma, death
DivalproexPolycystic ovaries, nausea, increased appetite, wt gain, sedation, thrombocytopenia, hair loss, tremor, vomiting, rare pancreatitis or liver failureBaseline: height and wt, pregnancy test (sexually active female patients), liver function tests, CBC
Wt gain may be additive when combined with an atypical antipsychotic28Every 6 mo: divalproex level, liver function tests, CBC
CarbamazepineMultiple medication interactions (decrease or increase the other medication levels including oral contraceptive failure), sedation, ataxia, dizziness, blurred vision, nausea, vomiting, aplastic anemia, hyponatremia, Stevens-JohnsonBaseline: CBC
Every 6 mo: carbamazepine level, CBC
LamotrigineSevere cutaneous reactions (risk 3 times greater <16), dizziness, tremor, sedation, asthenia, headache, interactions with oral contraceptives; case reports of leucopenia, agranulocytosis, hepatic failure, multiorgan failureBaseline: CBC and liver function tests
OxcarbazepineHyponatremia, oral contraceptive failure, cutaneous reactions, cognitive symptoms, sedation, coordination difficulties, nausea, vomiting, asthenia, headache, dizziness26Baseline and periodic: serum sodium
GabapentinMostly benign; most common are sedation, dizziness, tremor, headache, ataxia, fatigue, wt gainNone
TopiramateOral contraceptive failure, sedation, fatigue, impaired concentration, psychomotor slowing, word-finding difficulties, nephrolithiasisBaseline and periodic: serum bicarbonate
  • BUN, blood urea nitrogen; CBC, complete blood cell (count); EKG, electrocardiogram; TFT, thyroid function test.