General considerations concerning combining mood stabilizers

General considerations

1. The goal of this table is to offer a guide for physician and pharmacist in combining mood stabilizers. The table should be clear, easy to use and contains the most important information. Therefore, the table only contains the most commonly used mood stabilizers.
2. It should be noted that the table only contains a general advice. Deviant metabolism, comorbidity, the elderly etc. needs tailor-made pharmacotherapy!
3. For an effective therapy it is not necessary that the combining drugs have both therapeutic plasma levels. Combining different mood stabilizers will have a synergistic effect.
4. The combination of mood stabilizers may have possible synergistic effects. However, the combination will also have additive side effects. Therefore it is recommended to monitor the pharmacologic response to the drugs.
5. It takes approximately 3-5 times the half-life for a drug to reach steady state plasma levels or to be completely eliminated.
6. Enzyme inhibition is a direct effect and reaches maximum when the drugs are at steady-state. However, enzyme induction will take more time since it is dependent to the enzyme production.
7. Warnings and advice are limited to the combination only. Specific drug properties can be found through the links on the right side of each webpage.
8. Cytochrome P450 drug interactions between different mood stabilizers were checked with the Flockhart interaction table.
9. See disclaimer.